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TREATISE 



ON 



THE DENTAL ART, 



FOUNDED 

ON ACTUAL EXPERIENCE. 

by ty/o hundred and forty-one Sgnres in Lithography, and fifty-four Wood Cuts. 

BY F. MAURY, ; 

DENTIST OF THE ROYAL POLYTECHNIC SCHOOL. 

WITH NOTES AND ADDITIONS, 

BY J. B. SAVIER, 

DOCTOR OF DENTAL SURGERY. 



PHILADELPHIA: 
LEA AND BLANCHARD 

1843. 



SEntereti according to the Act of Congress, in the year 1843, by Lea & 
Blanchard, in the Clerk's Office of the District Court of the Eastern 
District of Pennsylvania. 



i 



W. S. Young, Printer. 



/ 



TO 

C. A. HARRIS, M. D., D. D. S. 

PROFESSOR OF PRACTICAL DENTISTRY IN THE BALTIMORE 
COLLEGE OF DENTAL SURGERY, 

As a memorial of respect and esteem for his professional 
worth, and zeal in behalf of the Dental 
Profession, by which its interests 
have been enhanced and its 
character elevated, and as 
a tribute of grateful 
affection, 

This volume is inscribed 

By his Friend, 

THE TRANSLATOR. 



PREFACE. 



The reputation of the author of this Treatise entitles 
his opinions upon the various subjects connected with 
the science of dental surgery to deference and respect, 
and it is believed will win for the present version of 
it a favourable reception. 

The translator has endeavoured to give a faithful 
interpretation of the views of his author, and would 
have preferred essaying no farther than this, did not 
the many improvements made in this department of 
the curative art within a few years past render it ne* 
cessary that he should omit or condense certain pas- 
sages that would in the present condition of the sci- 
ence be of no profit, and to append notes to others to 
explain or to refute whatever appeared ambiguous or 
erroneous. 

Of the third part he need only remark, that although 
it contains information of value to every dentist, it 
would not serve as a guide in the department of the 
art to which it is devoted. The necessity of other in- 
formation was therefore so manifest that the Treatise 
of Dr. Solyman Brown, the most complete upon this 

1* 



VI 



PREFACE. 



subject extant, has been levied upon to atone for this 
deficiency. 

The translator also makes his acknowledgments of 
the obhgations he is under to the various other au- 
thors whose writings he has without ceremony appro- 
priated to his use. He has made such selections with 
his best discrimination, and it is his highest hope that 
in his humble vocation of translator and compiler his 
labours may prove of utility to the members of his 
profession. 

J. B. S. 

Baltimore, December, J842, 



CONTENTS. 



PART 1. 



ANATOMY AND PHYSIOLOGY. 

Page 

The mouth and its appendages 15 

The lips or anterior wall of the mouth 15 

The palate, or posterior walls of the mouth 16 

The cheeks J or lateral walls of the mouth 17 

The palatine roof, or superior part of the mouth 18 

The base, or inferior part of the mouth 19 

The tongue 19 

The different parts that enter into the formation of the mouth. 20 

The bones 20 

M uscles of the mouth 20 

Nerves 21 

Arteries , , , 21 

Veins , 21 

Salivary glands 22 

The parotid gland 22 

The sub-maxillary gland 22 

The sub-lingual gland 22 

The teeth in general 23 

The incisores 25 

The cuspidati 25 

The bicuspides , 26 

The molares - - 26 

Teeth of first dentition 27 

Structure of the teeth 28 

Enamel of the teeth » . . . . 28 

Osseous part of the teeth ^ 30 

Dental pulp 31 

Development of the teeth 32 



viii CONTENTS. 

Mechanism of the eruption of the teeth 35 

Varieties of number 37 

Varieties of form 37 

Varieties of position 37 

Varieties of structure and consistency 37 

Uses of the teeth 38 

Mechanism of the eruption of the teeth of first dentition 38 

Mechanism of the eruption of the teeth of second dentition 40 

First and second dentition and the means of preventing evils that 

may result therefrom 44 

Salivation or ptyalism 4G 

Inflammation, swelling and pain in the glands. 48 

Convulsions 50 

Diarrhoea, accompanied by vomiting 51 

Constipation 52 

Second dentition and the evils that accompany it 53 

Evils that accompany the eruption of the third molar teeth 55 

DENTAL PATHOLOGY. 

Sect. I. Arrangement of the teeth 57 

Inversion of the dental arches C3 

Sect. II. Diseases of the dental substance 65 

Denudation of the teeth 6() 

Cracking of the teeth 68 

Fractures of the teeth 70 

Erosion of the teeth 73 

Decomposition of the enamel 74 

Discoloration of the teeth , 75 

Caries of the teeth 77 

Calcareous decay 81 

Peeling decay 83 

Perforating decay. .. o 83 

Black decay 83 

Diruptive decay 84 

Stationary decay , 84 

Decay resembling denudation 84 

Destruction of the roots of teeth. 85 

Exostosis of the teeth . 86 

Spina ventosa g7 

Necrosis of the teeth 87 

Inflammation of the alveolo-dental membrane.... S3 



CONTENTS. ix 

Inflammation of the dental pulp 8S 

Fungus of the dental pulp 90 

Ossification of the dental pulp 90 

SscT. III. Diseases of the teeth relative to their connexions 91 

Loosening of the teeth, &c 91 

Luxation of the teeth 92 

Loosening of the teeth 95 

Replacement of the teeth in their sockets 95 

Dental tartar 96 

Odontalgia, or toothache 101 

Pain occasioned by disease of the teeth 301 

Pain proceeding from disease in the surrounding parts 101 

Pain in the teeth from exterior causes 102 

Means of remedying pain in the teeth and surrounding parts. 102 

The gums and their various morbid affections 107 

Sect. I. Inflammation of the gums 108 

Aphthae 108 

Phlegmasia resulting from the perforation of the gums at 

the period of dentition 110 

Phlegmon or abscess of the gums Ill 

Fistulous ulcers of the gums 113 

Adhesion of the gums to the cheeks 114 

Sect. II. Swelling and various ulcerations of the gums 115 

Afiections of the gums in scorbutus 115 

Gangrene of the gums , 118 

Affections of the gums in scrofula 118 

Affections of the gums occasioned by syphilitic virus 118 

Affections of the gums caused by the use of mercury 119 

Sect. HI. Fungus of the gums 120 

Fungous tumours, or epules 120 



PART 11. 

DENTAL HYGIENE AND THERAPEUTICS. 
General means of preserving the teeth and all other parts of the mouth 



at all periods of life 125 

Means of preserving the gums 126 

Dentifrices, powders, opiates, liquids, elixirs, &c 127 

Charcoal 127 

Soot 127 



X CONTENTS. 

Bark 128 

Salt 128 

Alum, cream of tartar, oxalic acid 128 

Detersive powder « 128 

Detersive and tonic powders * * . . * , 129 

Acidulated dentifrices 129 

Opiates and mixtures 129 

Liquors, elixirs and tinctures for the mouth 130 

Philodontic and antispasmodic liquid 130 

Tonic elixir. j * 131 

Instruments and materials used for cleaning teeth ^ ........ . 133 

Brushes 133 

Sponge, or cotton 133 

Tooth-picks 134 

Roots 134 

Coral sticks 134 

General rules for the preservation of the teeth 134 

The various operations appertaining especially to the Dental Art, and 

the different instruments proper for their performance 136 

Operations relating to the teeth, and designed to facilitate their erup- 
tion 136 

Manner of directing second dentition 137 

Mode of correcting irregularities 139 

Removal of dental tartar and the instruments proper in the operation 141 

Manner of filing teeth 143 

Cauterizing the teeth 147 

Manner of plugging teeth 150 

Manner of luxating teeth 153 

Manner of extracting teeth 155 

Instruments for the extraction of teeth 158 

Garengeot's key, and the manner of using it 158 

Garengeot's key improved 160 

The curved shaft 160 

Point of support 161 

Hooks describing nearly right angles 161 

The straight forceps 161 

The curved forceps 162 

The curved hawks-beak forceps. ..... 162 

The straight hawks-bill forceps 163 

The simple elevator 163 

The fish tongue 163 

The excising forceps 164 



CONTENTS. . xi 

Precautions after the extraction of teeth 168 

The accidents that may result from the extraction of teeth 168 

Pain of the teeth after extraction and attendant evils 169 

Contusions and lacerations of the gums 169 

Fracture of the alveolar process 170 

Hemorrhage 170 

Rupture of the maxillary sinus, fracture of the alveolar arches, and 

luxation of the jaw 172 

Loosening, fracture and complete extraction of the teeth 174 

Loosening of the teeth 174 

Fracture of the teeth 174 

Accidental extraction of one or more of the teeth 175 

Transplanting teeth 175 

PART III. 

MECHANICAL DENTISTRY, OR ODONTOTECHNY, AND THE 
MECHANICAL MEANS OF REMEDYING LESIONS OF THE 
PALATINE ARCH. 

General considerations upon artificial teeth 179 

Artificial teeth 180 

Bones of the ox 181 

Teeth of oxen, horses and cows 181 

Ivory 181 

Mother of pearl 182 

Hippopotamus 182 

Tooth of the whale 183 

Human teeth 183 

Incorruptible teeth 1 85 

Wax o 187 

The various modes of taking impressions, making moulds, stamping 

plates, &c 189 

Manner of preparing a mould of wax 191 

Manner of preparing a sulphur mould. 191 

Manner of obtaining a metal mould 191 

Manner of stamping plates 192 

Manner of inserting artificial teeth 193 

Preparation of a root previous to the attachment of an artificial crown 193 

Pivot teeth, and the manner of inserting them 194 

Ligatures, plates and clasps used to retain artificial teeth 197 



xii CONTENTS. 

Ligatures 198 

Raw silk 198 

China root 198 

Thread of aloes... 198 

Metallic ligatures 198 

Plates, clasps and springs 199 

Plates 199 

Clasps 199 

Springs 199 

Artificial teeth, their fabrication, and mode of attachment 199 

Teeth' carved from the sea-horse tooth 199 

Natural teeth mounted upon the sea-horse tooth base 200 

incorruptible teeth mounted upon sea-horse tooth base 201 

Human teeth mounted upon a metallic plate 201 

Incorruptible teeth 202 

Mode of application 202 

Manner of adapting the shape of artificial (eeth 202 

Manner of soldering a pivot to an incorruptible tooth 203 

Complete sets, and the means of their attachment 204 

Complete sets made of the sea-horse tooth 205 

Complete dentures of human and incorruptible teeth upon a base of 

sea-horse tooth 206 

Complete sets of human teeth upon gold or sea-horse teeth bases 206 

Superior dentures maintained by means of a metallic plate adapted to 

tb e inferior j aw 206 

Manner of attaching dentures in the mouth by means of spiral springs. 207 

Manner of making spiral springs 207 

Spring carrier 208 

Obturators, or the means of remedying lesions of the palatine arch.. . 208 

Obturators sustained by sponge 209 

Obturators sustained by clasps 210 

Obturators sustained by a button 210 

Obturators sustained by a bolt 210 

Obturators with moveable wings 210 

Obturators connected with dentures 211 

The care necessary for the preservation of artificial teeth 211 

Artificial gums 212 

Treatise on Mechanical Dentistry 213 

Alphabetical Table of Authors on Dental Surgery, &c 267 

Description of Plates 287 



PART I. 

ANATOMY AND PHYSIOLOGY. 

♦ 



TREATISE. 



PART I. 

ANATOMY AND PHYSIOLOGY, 

THE MOUTH AND ITS APPENDAGES. 

The mouth is an oval cavity placed between the jaws, bounded 
laterally by the cheeks, anteriorly by the lips, posteriorly by 
the palate, superiorly by the palate bones and the palatine pro- 
cesses of the superior maxillary bones, and inferiorly by the 
tongue and buccal membrane. 

As the anatomy of this cavity should precede the descrip- 
tion of its various diseases, we deem it necessary tp examine 
briefly its different parts, and also their respective functions; 
for, without such examination, it would be as difficult to un- 
derstand the nature of its diseases as it would be to arrest their 
progress by the judicious employment of hygienic and thera- 
peutical means, or to perform the operations to be hereinafter 
described. 

The Lips, or Anterior Walls of the Mouth. 

The lips are two symmetrical, membranous, moveable folds, 
which flatten from without inward; they are situated in front 
of the maxillary bones, and separated by a transverse slit, 
called the opening of the mouth. The skin, hair, muscles, se- 
baceous glands, mucous follicles, cellular tissue, arteries and 
veins, capillaries and lymphatics, nerves, and a mucous mem- 
brane, form the tissues of their organization. The lips are 
also composed of muscular fibres, so arranged as to enable them 
to execute the different movements necessary in the perform- 
ance of their functions. 



16 



Maury's dental art. 



The skin which covers the exterior of these organs is thin, 
very fine, and of a serous tissue; it adheres strongly to the 
subjacent parts by a cellular tissue, which contains no fat, and 
in the male subject at puberty is covered with beard. The 
mucous membrane which lines the mouth is reflected over 
their borders, and gradually blends with the skin. This mem- 
brane is remarkable for its redness and its strong epidermis; 
it covers numerous mucous follicles, the orifices of which are 
within the lips. 

The muscles of the lips have each a peculiar form and a 
distinct point of insertion. Some of these are common to 
both lips, and others appertain to one only. The first class 
are the zygomaticus major, depressor anguli oris, caninus, buc- 
cinator, and the orbicularis oris; the second class are the levator 
labii superioris alaeque nasi, levator proprius, and the zygoma- 
ticus minor, which act upon the superior lip, and the muscles 
of the chin, the action of which is upon the lower lip, (PI. I. 
Fig. 1.) 

The arteries of the lips are branches of the external carotid, 
especially the labial, the sub-mental, the mental, the buccal, 
the sub-orbital, the alveolar, and the transversalis facii. 

Their veins follow the course of these arteries, and empty 
into the jugulars. 

Their nerves are branches of the sub-orbital, the mental, and 
the facial nerves. 

With respect to their lymphatics, they enter into the forma- 
tion of ganglions situated under the chin. 

The Palate, or Posterior Wall of the Mouth. 

The palate is a species of moveable partition. It is soft, 
wide, thick, and of a quadrilateral figure, attached above to the 
palatine arch, on the sides to the walls of the pharynx, on 
each side by two folds of the buccal membrane; below it is 
free, and is called the pillars of the palate. These pillars are 
separated from each other, by a mass of muciparous follicles, 
which are called the amygdalcB. 

The posterior opening of the mouth is situated under the 
palate; it is bounded by the root of the tongue, the palate, its 
pillars, the palatine roof, and the tonsils. 



ANATOMY AND PHYSIOLOGY- 



17 



The palate is composed of a mucous and a muscular coat; 
the first, which forms a species of duplicature, in which the 
muscular coat is contained, is continuous anteriorly with the 
membrane of the mouth, and posteriorly with that of the nasal 
fossas. This membrane is lined with a great quantity of mu- 
cous follicles, of a yellow colour, very serous, round, and form- 
ing of themselves nearly the thickness of the uvula. 

The second, or muscular coat, is formed by the azygos 
uvula and the internal and external palato-pharyngeus, the 
pterygo-staphylius, the salpingo-staphylius and the glosso- 
staphylius. The use of these muscles is to- move the soft 
palate. 

Its arteries are branches of the labial, the palatine, and the 
superior pharyngeus. 

- Its veins unite with those of the tongue and pharynx, and 
empty into the internal jugular. 

Its nerves are furnished from the ganglion of Meckel and 
the glosso-pharyngeus. 

The CheekSi or Lateral Walls of the Mouth, 
The cheeks, which do not constitute distinct organs, form 
the lateral walls of the mouth. They are flattened transversely, 
broad, of a quadrilatei^al figure, and their thickness varies irx 
different individuals. They have exteriorly no distinct limits, 
but are continuous with the inferior eye-lid above, and below 
they descend to the base of the jaw. They are limited ante- 
riorly by the wings of the nose, and posteriorly by the pos- 
terior border of the rami of the jaws. Interiorly they are 
bounded above and below by duplicatures of the mucous mem- 
brane of the mouth; posteriorly by the anterior pillars of the 
palate, and anteriorly by the commissures of the lips. Their 
external surface may be either convex or concave; on their 
internal surface are scattered numerous buccal glands, and oppo- 
site the space between the second and third molares the ducts of 
Steno are situated, one on each side. 

The -cheeks are composed of three distinct coats, the der- 
moid, the muscular, and the mucous coats. 

The first, or dermoid, is very fine, and in male adults is partly 
covered with beard. 



IS 



Maury's dental art. 



The second or muscular, is composed of the muscles already- 
named, namely^ the buccinator, the masseter, the zygomatic! 
major and minor, and a portion of the platysma-myoides, (PI. 
I. Fig. 1.) 

The third, or mucous, is thinner in the cheek than in any- 
other part of the mouth. The molar glands are situated pos- 
teriorly, between the buccinator and masseter muscles. They 
are composed of agglomerations of sub-mucous follicles, the 
excretory orifices of which are opposite the last molar tooth. 

The arteries of the cheek are branches of the labial, trans- 
versalis facii, buccal, superior alveolar, and sub-orbital arteries. 

Their veins correspond to their arteries, and empty into the 
two jugulars. 

Their nerves are branches of the suborbital, facial, buccal, 
masseter and cervical plexus. 

The Palatine Roof, or Superior Part of the JVIouth 

The palatine roof, or superior part of the mouth, is a species 
of paraboloid arch; it is horizontal, slightly concave, immova- 
ble, traversed longitudinally by a medial line of a whitish, 
colour and slightly depressed, and terminating in front between 
the incisores by a slightly elevated tubercle corresponding to 
the inferior orifice of the anterior palatine foramen. The pa- 
latine roof is surrounded by the superior teeth, which we will 
hereafter describe in detail. 

The osseous portion of the palate is formed by the superior 
alveolar arch, the palatine processes of the superior maxillary 
bones, and the palate bones. 

Its mucous membrane is thinner and of a lighter colour than 
in any other part of the mouth; at its anterior part, which is 
the thicker part, it presents transverse ridges varying in 
number and extent. Smooth at its posterior part, this mem- 
brane is covered with numerous holes which are the excretory- 
orifices of mucous follicles situated between it and the osseous 
wall of the palate. It is continuous in front and upon the sides 
with the gums, and is a species of fibro-mucous tissue, reddish, 
firm, destined to cover the two sides of the alveolar arch, and 
accurately fills up the spaces between the teeth the necks of 
which it surrounds. This tissue, the nature of which is little 



ANATOMY AND PHYSIOLOGY. 



19 



understood, is identified in some manner with the periosteum 
of the two alveolar arches, and is continued exteriorly with 
the internal membrane of the cheeks and lips. 

The gums appear to be formed of a pulpous and fibrous 
layer, which is reflected over the mucous membrane. They 
are highly vascular. 

The arteries of the gums, like those of the palate, are branches 
of the palatine, alveolar, sub-orbital, labial, and buccal; those of 
the inferior gums are, more especially, branches of the mental 
and sub-m.ental arteries. Their veins are from the internal 
and external jugulars, and their nerves are furnished by the 
palatine, facial, sub-orbital, superior and inferior dental; and 
the naso-palatine ganglion. 

The Base, or inferior Part of the Mouth. 

The inferior part of the mouth is larger posteriorly than 
anteriorly, and forms beneath the tongue a duplicature called 
the frasnum linguae. Here are seen the inferior jaw, surround- 
ed by its teeth; the tongue, which occupies the entire space 
between the branches of the jaws; and the mucous membrane, 
which invests the whole. 

The Tongue. — The tongue is a symmetrical organ, almost en- 
tirely muscular, of a flat, oblong form, rounded at its border 
and point, thick in its centre, but more so at its base; it occu- 
pies the mouth, the cavity of which it fills when the jaws are 
closed. It extends from the os hyoideus and the epiglottis as 
far as the posterior part of the incisores. It is anatomically 
divided into two faces, two borders, and two extremities, (the 
dental extremity, or its point, the hyoidean extremity, or its 
base.) 

The tongue is chiefly formed of a peculiar tissue of muscles, 
and of a mucous membrane, which is a continuation of the 
lining membrane of the mouth. These m.uscles are the hyo- 
glossus, genio-glossus, stylo-glossus, superficial and deep-seated 
Unguals, and the transverse and vertical Unguals. 

The floor of the mouth, beneath the tongue, is formed by 
the following muscles: the genio-hyoideus, the mylo-hyoideus, 
the digastricus and the platysma-myoides, and finally by the 
skin. The nerves which are distributed to the floor of the 



20 



maurt's dental art. 



mouth are the Unguals, the glosso-pharyngeus, the hypo-glossus, 
the facial, the superficial cervicals, and a branch of the inferior 
dental nerve. The arteries are the sub-linguals, inferior pala- 
tine, and sub-mental. Veins and many lymphatic plexi are 
also observed here. 



THE DIFFERENT PARTS THAT ENTER INTO THE FORMATION 
OF THE MOUTH. 

The Bones. 

The bones that enter into the formation of the mouth are 
the superior maxilla, which forms the whole of the superior 
jaw; the palate bones, situated posteriorly; the inferior jaw ; 
and the teeth. The development of the teeth presents pecu- 
liar phenomena, which we will explain in the chapter devoted 
to the description of these little organs, when we will endea- 
vour to omit nothing either in relation to their structure or the 
mechanism of their eruption. 

Muscles of the Mouth. 

Some of these muscles appertain to the walls of the mouth, 
and others form a part of this cavity as they enter into the for- 
mation of organs which constitute it. 

The following muscles are under the jaws in the base of the 
mouth: 1, platysma-myoides; 2, digastricus; 3, mylo-h}- oideus; 
4, genio-hyoideus. These draw the jaw downward and back- 
ward. 

There are also: 5, stylo-glossus ; 6, genio-glossus; 7, hyo- 
glossus; S, deep and superficial Unguals; also, the transverse 
and vertical linguals which Dr. Gerdy has recently discovered, 
and which appertain solely to the tongue. 

There are other muscles that belong to the cheeks and lips: 
1, the temporal; 2, the masseter ; 3, the pterj^goideus internus, 
which constitutes the levator of the inferior jaw; 4, the ptery- 
goideus externus ; 5, the two zygomatici ; 6, the two levators 
of the superior lip; 7, the canini; 8, the two depressors of the 
lips, which; as their names indicate, are the movers of the lips; 



ANATOMY AND PHYSIOLOGY. 



21 



9, muscle of the chinj 10, the buccinator; 11, the labial. (PI. 
I. Fig. 1.) 

The muscles of the soft palate may also be named here, viz: 
glosso-staphylius; 2, palato-pharyngeus; 3, salpingo-pharyn- 
geus; 4,peristaphylus; 5, azygos-uvulas. These comprise all the 
muscles of the mouth. 

J\*erves. 

The nerves which are distributed to the different parts of 
the mouth, already described, are branches of the fifth, seventh, 
eighth and ninth pairs. 

The branches of the fifth pair, which supply the different 
parts of the mouth with nervous fillets, are the superior and 
inferior maxillary. (PI. I. Fig. 2, PI. II. Fig. 2.) The first of 
these branches furnishes the posterior and anterior dental 
nerves, and forms the spheno-palatine ganglion. The second, 
the masseter, deep temporal, buccal, pterygoid, superficial, 
temporal, lingual and inferior dental nerves. (PI. I. Fig. 2, 
PI. II. Fig. 1.) 

The portio dura of the seventh pair, or the facial nerve, dis- 
tributes to the cheek the buccal and malar branches, and under 
the chin it sends off the mental and submental branches. (PI. 
I. Fig. 2.) 

The eighth pair sends off the glosso-pharyngeus, which is 
distributed in the mouth. 

The ninth pair, or the great hypo-glossal, is exclusively dis- 
tributed to the tongue. 

Arteries. 

The arteries that nourish the different parts of the mouth are 
branches of the external carotid; they are the lingual, the 
musculo-palatine, the sub-mental, the tonsillaris, the inferior 
labial and its two coronaries, the inferior dental, the masseter, 
the buccal, the alveolar, the sub-orbital, the superior palatine, 
and the spheno-palatine. (PI. II. Fig. 2.) 

Veins. 

The veins follow the course of the arteries and receive the 
same names, but they are more numerous and more compli- 
cated. (PI. II. Figs. 1, 2.) 



22 



maurt's dental art. 



Salivary Glands. 

The salivary glands we shall speak of as accessories of the 
mouth are the parotid, the sub-maxillary and the sub-lingual. 

The parotid Gland. — This gland, the largest of all the salivary 
glands, is situated on the side of the face between the mastoid 
process of the temporal bone and the ramus of the lower jaw, 
the external auditory conduit, and the mastoid apophysis of the 
temporal bone. It presents the form of an irregular pyramid 
inverted, and extending vertically from the zygoma to the an- 
gle of the jaw. 

It is nourished by branches of the transversalis facii and 
the anterior auricular arteries. The veins distributed to this 
part return into corresponding trunks. Its nerves derive their 
origin from the facial, the inferior maxillary branches, and the 
cervical plexus. As regards its lymphatics, they are very nu- 
merous and enter into ganglions situated behind the angle of 
the jaw. The use of the parotid gland is to secrete the saliva. 

The sub-maxillary Gland. — This gland is smaller and not 
so solid as the preceding; it is of an irregular ovoidal form, 
flattened upon three of its sides, and bifurcated in front. It is 
situated on the internal side of the branch and body of the 
lower jaw, in the space between the two bellies of the digastric 
muscle, and bears a strong resemblance in colour, consistency, 
and internal structure, to the parotid. 

It receives its nourishment from branches of the facial and 
lingual arteries. 

Its veins are branches of the neighbouring venous trunks, 
and its nervous twigs are supplied by the lingual and inferior 
dental nerves and the sub-maxillary ganglion. 

This gland, like the parotid, secretes a great quantity of 
saliva, which is carried into the mouth by a canal called the 
duct of Wharton. 

The sub-lingual Gland. — This gland is of an ovoidal form, 
slightly flattened transversely, and resembling an almond di- 
vested of its shell. It is situated in the substance of the infe- 
rior portion of the mouth under the anterior part of the tongue. 

Its organization is the same as that of the other salivary 
glands. It is red and firm, and the lobes or lobules of which 



ANATOMY AND PHYSIOLOGY. 



23 



it is composed are smaller than those of the sub-maxillary 
gland. It has about twenty excretory ducts of extreme tena- 
city occupying different situations. Some pierce the mucous 
membrane, covering the floor of the mouth, and others have 
their orifices upon the lateral parts of the freenum of the tongue. 
Two or three, and even more, have been known to open into 
the duct of Wharton. 

Its arteries are branches of the labial and sub-mental. 

Its nerves are furnished by the inferior maxillary and the 
hypo-glossal. 

Its use is the same as the preceding glands. 

As we designedly neglected to give the history of the teeth, 
when treating of the superior and inferior walls of the mouth, 
we will now notice them in a particular manner. 

THE TEETH IN GENERAL. 

The teeth, together with the alveoli in which they are im- 
planted, and the jaws, constitute the dental apparatus, properly 
so called. The first of these are the hardest and most compact 
bones of the body. " They form,'^ says Beclard, '^upon the 
alveolar arch, by an uninterrupted series, two curved parabo- 
loid lines, which are called the dental arches. These being un- 
equal, the superior represents the large extremity of an oval, 
and the inferior the small extremity of the same oval. The 
superior arch overlaps the inferior. The free border of each 
dental arch is thin and simple in front, thick and double on 
the sides, where the teeth are larger and furnished with two 
rows of tubercles. 

The teeth differ in structure and mode of growth and nutri- 
tion, from other bones of the body; and, although they resem- 
ble them in their chemical and physical properties, they differ 
from them in many other respects. They vary in number at 
different periods of life, are partly exposed to the atmosphere, 
and often drop out during old age. They are covered with an 
enamel of pearly whiteness, which is peculiar to them, and 
which assumes, according to the temperament of the indivi- 
dual, a blue, yellow, or gray hue.* Together with these there 

* The colour, shape, and size of the teeth are not only indicative of the tem- 
perament of the individual, but they indicate their liability to decay. For a 



24 



maury's dental art. 



- is another hue very common to the teeth, but not so distinct; 
it is slightly red, which is caused by the artery and vein which 
penetrate the little orifice at the extremit}^ of each root, (PI. 
II. Fig. 2,) and nourish the dental pulp found at the middle 
of the interior of the crown. (PI. IV. Fig. 4.) The teeth ge- 
nerally assume a slightly vertical direction. They are of the 
form of an irregular cone, their crowns representing the base 
and their roots, single or double, pierced at their extremities, 
and buried in their sockets, representing the summit of the 
cone. (PL VI. Fig. 3.) 

Each tooth has a part called the crown, projecting beyond its 
alveolus and covered with a thick enamel. This, in a 
healthy state, protects the tooth from the impressions of heat 
and cold. The crown is surrounded by a slight depression 
called the neck, around which the gums adhere and separate it 
from an articular portion, called the root, which is buried in 
the alveolus. The roots may be single, double, triple, quad- 
ruple, and sometimes quintuple, according to the class of teeth, 
(PI. VII. Figs. 11, 18, 24,) and are covered with a thin perios- 
teum or vascular membrane which lines the alveolus and be- 
comes a means of securing the teeth by a species of articulation 
known among anatomists as gomphosis, resembling the union 
of a nail with a board into which it has been driven. 

There are in the human mouth, when second dentition is 
completed, thirty-two teeth. These are divided into classes, 
uniform within themselves, and having corresponding sides in 
contact. (PI. VIL Figs. 11 to 26.) 

The teeth are thus classified, viz: — Incisores, Cuspidati, Bi- 
cuspides and Molares. It will be perceived by their respective 
shapes (PI. VII. Figs. 1 to 26) that nature intended them for 
different uses. The incisores, situated in front, are intended 
to cut similarly to a pair of scissors; the cuspidati appear to be 
destined to seize and tear aliment like those of carnivorous 
animals; and the bicuspides and molares, flattened upon the 
crown and provided with conical tubercles, are to grind ani- 
mal and vegetable aliment. 

full description of the appearances of the teeth, and their local and constitu- 
tional indications, the reader is referred to Professor Chapin A. Harris' Trea- 
tise on the Physical Characteristics of the Teeth and Gums, Chap. 11. — S, 



ANATOMY AND PHYSIOLOGY. 



25 



The Incisores. — The incisores are divided into superior and 
inferior centrals and laterals. They are eight in number, four 
in each jaw, occupying the anterior and smaller portion of the 
arch. Their bodies are quadrilateral, narrower and thicker 
near the root than at its extremity, convex, smooth and po- 
lished ill front, and concave and narrow behind. They have 
upon each side a triangular surface, contiguous to the neigh- 
bouring tooth, and separated from the root by a neck present- 
ing anteriorly and posteriorly the form of a paraboloid border. 
These teeth have always single roots, which are long, conical 
and pointed, compressed laterally, and fluted lengthwise upon 
each side. At their points there is a foramen, through which 
pass a nerve, artery and vein. 

The two superior central incisores are always larger and 
stronger than the superior laterals, and the latter somewhat ex- 
ceed the inferior in size and strength. The axis of each of the 
four superior incisores, situated below and in front, is a little 
inclined toward its fellow, and the external border of their 
bodies is rounded near the gums, while their extremities are 
brought down to a cutting edge. (PI. VII. Figs. 11, 12.) 

The inferior incisores, we have already said are narrower 
and not so strong as the preceding. The _centrals are a little 
smaller than the laterals. The edges of the inferior are inclined 
obliquely inward, a disposition, says Garriot, that is caused by 
the friction produced upon their anterior surfaces by the supe- 
rior teeth. Their axis is vertical, their roots longer, narrower 
and more deeply fluted than those of the superior incisores. 
(PI. VII. Figs. \ 9, 20.) 

The Cuspidati. — The cuspidati are four in number, two in 
each jaw, one on each side of the four incisores. They have a 
conical body, are very convex anteriorly, a little irregularly 
concave posteriorly, and terminating in a point or tubercle 
which is often beyond the level of the other teeth. Their 
roots are single, but much longer and thicker than those of the 
incisores, and the extremity is som.etimes separated into two 
branches, having the appearance of two united, (PI. VIII. Fig. 
19.) They are flat and rough upon their sides, and, like the 
incisores, their necks have anteriorly and posteriorly two 
curves. 

3 



26 



maury's dental art. 



The superior cuspidati are the longest of all the teeth. Their 
roots often penetrate the base of the sub-maxillary bone. 

The inferior cuspidati are smaller, and situated upon a more 
anterior plane than the adjoining teeth. (PI. VII. Figs. 13 
and 2 1 . 

The Bicuspides. — These occupy the lateral part of the mouth, 
four in each jaw, and are placed posterior to the cuspidati. 
Their bodies, the greatest dimension of which is in length, 
slightly resemble the cuspidati. They are cylindrical anteriorly 
and posteriorly, flattened laterally, larger at their external than 
at their internal sides, and are surmounted by two short conical 
tubercles, one external, large and prominent, the other internal, 
small and less elevated. These tubercles are more prominent 
upon the superior than upon the inferior bicuspides, and there 
are between them two uneven depressions. 

The root of the bicuspides is flat, deeply fluted anteriorly 
and posteriorly. The first two superior and the four inferior 
bicuspides have generally one single root; but the two poste- 
rior superior have each two roots, which have at their extre- 
mities two foramina, through which pass nerves and vessels. 
The necks of these teeth describe a more irregular circle than 
the preceding. (PI. VII. Figs. 14, 15, 22, 23.) 

The Molares. — The largest of all the teeth terminate the 
dental arches, and are twelve in number, six in each jaw. 
Their bodies are slightly cubical, short, partly round, but 
flattened posteriorly and anteriorly: their surface is surmounted 
by four or five tubercles with corresponding depressions, so ar- 
ranged that when the jaws are closed the tubercles of the molares 
of the upper jaw are adapted to the depressions of those of the 
lower jaw, and vice versa. These tubercles are separated from 
each other by deep winding grooves. The roots of these 
teeth are shorter than those of the bicuspides, and are divided 
into three, four, and sometimes five branches, through each of 
which pass a nerve, artery and vein. These branches may 
be more or less straight or curved, long or short, smooth or 
unequal, and sometimes, after diverging, they approach each 
other in such a manner as to embrace a part of the alvaolus. 



ANATOMY AND PHYSIOLOGY. 



137 



The neck is well marked. But the three molares differ so 
much from each other as to require a separate examination. 

The first is the largest of the three molares, and has upon its 
crown generally four, and sometimes five tubercles, three ex- 
ternally and two internally. The root of this tooth in the 
superior jaw is triple or quadruple, while that in the inferior 
is only double. (PI. VII. Figs. 16, 24.) 

The second molar is smaller than the preceding, is provided 
in the inferior jaw with four tubercles separated by a crucial 
groove which is less regular in the superior molar, the body of 
which is of a rhomboidal figure. Its root has three branches, 
two external and united, one internal and very divergent. (PL 
VII. Figs. 17, 25.) 

The third molar, commonly called the wisdom tooth, bears 
much resemblance to the second molar, but is smaller, and its 
axis is directed more inward. Its crown is round and furnished 
with three or four tubercles. Its root is generally single, 
grooved longitudinally, short, conical: sometimes it has the 
appearance of two, three, and even four fangs united partially 
or totally. (PI. VII. Figs, 18, 26.) 

Teeth of First Dentition- 

The teeth named thus in contradistinction to those which 
have already been described, are seen in children of from three 
to four years of age, and are twenty in number, ten in each 
jaw, when the first denture is complete. They differ so ma- 
terially from those of second dentition as to require a separate 
description. They have, according to their form and use, been 
divided into incisores, cuspidati and molares. Those in the su- 
perior are generally stronger than those in the inferior jaw. The 
deciduous incisores 3iud cuspidati, (PI. VII. Figs. 1,2, 3,) differ but 
little from the permanentes. They are smaller, and of an 
azure blue; they are brittle, and have long roots previous to 
their destruction by the teeth of replacement. 

The four temporary molares are of a difierent form from 
those which succeed them, and can only be compared to the 
permanent molares, from which however they greatly difier in 
conformation. The first molar of the superior jaw is larger 
than the cuspidati, and has upon its crown five tubercles, three 



28 



MAURY'S DENTAL ART. 



internally and two externally; its root has three divisions, two 
of which are united, (PI. VII. Fig. 4.) The second is larger 
and rounder than the first, and has five tubercles upon its 
crown, which is cylindrical, three upon its outer and two upon 
its inner part; it has three diverging roots, and near its neck 
a peculiar prominence. (PI. VII. Fig. 5.) The two molares of 
the inferior jaw are smaller and have generally only, two roots 
very strong and short. (PI. VII. Figs. 9, 10.) 

The teeth of first dentition are usually of a bluish white 
colour. The incisores and cuspidati are much smaller than those 
of the second denture, (PI. VII. Figs. 1, 2, 3, 6,7, 8, 11, 12, 
13, 19, 20, 21,) and their cutting edge is thinner, and their 
bodies rounder and more swollen, particularly the outer part. 
In regard to their chemical composition, they differ but little 
from the adult teeth. They have perhaps a little less of the 
phosphate of lime, as may be seen in the following table, in 
which we give the results obtained by Mr. Phelps of the 
analysis of^the teeth at different periods of life: — 



Phosphate of lime, 
Carbonate of lime, 
Cartilage, 
Water and loss. 



Temporary 
Teeth. 

62 
6 
20 
12 



Adult 
Teeth. 

64 
6 
20 
10 



Roots of 
Teeth. 

58 
4 
28 
10 



Enamel of 
Teeth. 

78 

6 


16 



STRUCTURE OF THE TEETH. 

Although anatomists and physiologists do not agree upon 
the nature of the different substances that enter into the com- 
position of the teeth, they in general acknowledge three dis- 
tinct parts, namely, first, the enamel, which covers the body of 
the tooth; second, the osseous part, or that which is called 
bone; third, the dental pulp, a gelatinous substance which fills 
the cavity of the tooth. 

Enamel of the Teeth. — The enamel of the teeth is a peculiar 
substance, semi-transparent, bearing a slight resemblance to 
porcelain; its colour in different subjects, and even in the dif- 
ferent teeth of the same subject, varies from a milky white- 



ANATOMY AND PHYSIOLOGF. 



29 



ness to a brown or yellow. It is smooth and polished, analo- 
gous to no other tissue of the system, and so durable that it 
resists the action of those causes which generally destroy bone. 
<^ It envelops the body of the tooth/' says Beclard, "and be- 
comes thinner at the neck, where it terminates. Its texture is 
fibrous; the fibres press against each other, and are directed 
from the circumference to the centre of the tooth, to which 
they adhere by their extremities." These fibres are fine, ad- 
hering to each other by their lateral surface, and in proportion 
to their length is the thickness of the enamel. 

The enamel of the teeth, with regard to its hardness, can 
only be compared to blue steel. It is capable of resisting fire, 
and produces fire when struck with the above named metal. 

It varies much in thickness; sometimes it forms the greater 
part of the crown, at other times is very thin. It is always 
thickest upon the tubercles or eminences of the teeth. When 
submitted to the action of fire it will become at first dark, and 
afterward tarnish, crack, become pliable after having resisted 
the heat for a longer period than the bone is capable of. When 
placed very near the fire it splits and drops off. In acid it 
dissolves into a light and white formless flake. The following 
is the analysis given by Berzelius of the different portions of 
the materials which enter into its composition: 



Phosphate of lime, ....85.3 

Carbonate of lime, .......8.0 

Phosphate of magnesia, „...1.5 

Membranes, soda and water, .0.2 

In speaking of the analysis of the teeth in general, we gave 
the analysis of the enamel as obtained by M. Pepys, who 
difiers from Berzelius simply in denying with M. Hatchett 
the existence of cellular and cartilaginous tissues in this sub- 
stance. Fourcroy, Vauquelin, and Berzelius are of an opposite 
opinion; for they have discovered in it a great quantity of 
these tissues. The enamel contains no vessels, and when 
once destroyed cannot be reproduced. M. Cuvier, adopting 
the opinion of Hunter, thinks that this substance is entirely 
inorganic. 

3* 



30 



maury's dental art. 



Osseous Pari of the Teeth. — This substance is of the form 
and nearly the entire size of the tooth, the root of which it 
forms exclusively. The neck is the largest part of the bony 
substance of the body. It has less tenacity, and is not so brittle 
as the enamel, and contains a cavity which occupies the centre 
of the crown, and is prolonged, gradually diminishing to the 
extremity of the root. The texture of the bone is extremely 
dense, and in it there can be discovered neither traces of ves- 
sels nor cellular medullary.* This substance is of a yellow 

* The opinion expressed by the author on this subject is, with scarcely an 
exception, now discarded by intelligent writers on dental physiology. " That 
the teeth presses vitally," says Thomas Bell, ''that they are connected by 
their organization with the general system, having nerves, blood vessels, and 
absorbents, and are analogous in this respect to other bones, is a truth so 
strongly attested by all the phenomena they present, whether in a healthy or 
a diseased state, that it is difficult to imagine upon what grounds it can have 
been controverted, or even doubted, by any one whose opinions are deduced 

from observation or experiment I have on purpose, by breaking a 

tooth immediately after extraction, when the pain and inflammation had been 
severe, found distinct red patches, in the very substance of the hone.'' 

"In certain varieties of asphyxia," Dr. H. H. Hayden remarks, " the ap- 
pearances of the teeth are not only singular, but highly instructive, in a phy- 
siological point of view especially. They are almost uniformly tinged red. 
If examined immediately after death, they present a deep pink hue; if some 
time after, the tint is darker. — The difierent shades of colour, however, will 
generally depend in a great measure upon the age of the person and the 
violence of the death: for instance, the bony structure of the teeth of young 
persons is far more transparent and vascular than those of persons advanced 
in years. These appearances are particularly observable in the teeth of such 
as have been drowned, and more especially in those that have been hanged. — 
They are, moreover, met with in the teeth of refractory bullocks that have 
been forcibly drawn into the slaughter house by means of a rope round tlie 
neck." 

"On examining the teeth," continues the same writer, " for the purpose of 
ascertaining, if possible, the nature of these appearances, I found, on splitting 
them open through the roots, or fangs (which ought to be done from the edge 
of the crown, so as not to touch or disturb the vessels of the tooth) the whole 
nervous pulp turgid, almost black, and even surrounded with blood. From 
this condition of the vessels, one might be led to suppose that the red tint 
of the teeth was reflected through the bone. But on removing the nerve, 1 
found that the bony substance of the tooth was literally injected with the colour- 
ing matter of the blood. And this so efiectually as to render every effort to 
return it to its natural whiteness, perfectly ineffectual." 

If farther proof were required on this subject, it could be supplied from 
the pages of the " American Journal of Dental Science," in which may 
be found reports of several cases in point made by Professor Harris and 
others.— S. 



ANATOMY AND PHYSIOLOGY. 



31 



tinge, and more compact than other bone, which appears to 
be owing to the great quantity of the phosphate of lime 
that it contains. The teeth appear to be formed of bony plates 
encased in each other, and adhering so strongly as to be insepa- 
rable; an arrangement not plainly manifested in their roots. 
When fractured, the teeth have generally a fine aspect. The 
dental bone withstands the air, but when submitted to the 
action of acid, its earthy part dissolves, and a compact, dense pa- 
renchyma remains, having neither a fibrous nor an areola aspect. 
When submitted to the action of fire it becomes black, burns, 
and leaves a hard, pliable, white residue, which is not the case 
with the enamel when submitted to the same process. 

The osseous part of the teeth, submitted to a critical analysis 
by Eerzelius, furnishes the following results: — * 



Phosphate of lime, 61.95 

Fluate of lime, 2.10 

Phosphate of magnesia, 1.05 

Carbonate of magnesia, 5.30 

Soda and chloride of soda, 1.40 

Cartilage, blood vessels and water, 28.00 



Dental Pulp. — We discover in the axis of a tooth a cavity 
which is continuous with the canal of the root, or canals, if 
there be more than one root. This cavity, which occupies the 
centre of the tooth, where it is largest, is filled in a fresh state 
with a soft, grayish substance called the dental pulp. " A 
species of ganglion,'^ says M. J. Cloquet, possessing great 
sensibility, and which is continuous with the vascular and ner- 
vous pedicle that enters through the root of the tooth, and 
which bears some resemblance to a bud. (PI. IV. Fig. 4.) 
This pulp, ov pulpous kernel, of the tooth, is only, according to 
Beclard and the generality of anatomists, a papilla of the mu- 
cous membrane of the mouth, which forms gums and lines the 
alveoli, and in the bottom of these cavities sends oif in that 
of the ivory a swollen prolongation which entirely fills it. 

* The analysis of the teeth is seldom attended with like results; but there 
is sufficient uniformity to predicate the modes of treatment suggested by a 
knowledge of their composition. Therefore we deem it unnecessary to ex- 
hibit here the minute differences between the above statements and those 
founded upon the experiments of others.— S. 



32 



MAURr's DENTAL ART. 



This papilla is provided with nervous and vascular rami, which 
distribute themselves particularly upon its surface; and the part 
that it performs in the mode of development of the teeth is 
not less important than that which it is destined to fulfil in 
their nutrition. It has been, from its great sensibility, com- 
pared to the gelatinous substance of the labyrinth of the ear. 
It is indeed by means of the dental pulp that we distinguish 
the differences of heat and cold. 

DEVELOPMENT OF THE TEETH. 

The teeth are not formed like other bones of the skeleton 
in a cartilaginous mould ; they are preceded in their develop- 
ment by organs called germs, and those of the deciduous teeth 
are visible in the foetus of about two months. (PI. III. Figs. 6 
to 15.) "These germs," says Beclard, '^consist of mem- 
branous follicles situated under the gums in the groove that 
commences to present itself along the jaws, where they form 
by their series two arches, a superior and an inferior, the germ 
of the cuspidatus excepted, which occupies a place anterior to the 
arch. But these alveolar arches, continuing to increase, at the 
epoch of the eruption of the teeth, the cuspidatus is found to be 
in a line with the rest. 

"This follicle, at first very small, but rapidly increasing, is 
ovoid^l, or of the form of an olive. It is buried in the midst 
of pulpous cellular tissue. By one of its extremities, which 
is deep-seated, it is connected to a vascular and nervous pedicle; 
by the other, which is superficial, it is connected to the under 
part of the gum, and has probably at this part a porous or 
imperceptible orifice of communication with the surface of that 
membrane. 

" The cavity of the follicle is at first of the same figure as 
the follicle itself, and occupies its whole extent. It is filled 
with a colourless limpid fluid, but containing some flakes. Its 
consistency is mucilaginous, but not viscous." At a more 
advanced period," the same author continues, "the follicle 
contains a species of vascular and nervous papilla of the same 
form, which, issuing from its deep extremity, and vegetating, 
to use the expression, in its interior; almost entirely fills it. 



ANATOMY AND PHYSIOLOGY. 



33 



It nevertheless holds to the adherent extremity of the follicle 
by a pedicle, and the whole of its remaining surface is free and 
bathed in liquor. The liquor diminishes in quantity in pro- 
portion to the increase of the papilla or dental pulp. The 
walls of the follicle are formed by a double mem.brane, the 
external leaf of which is white, opaque, tenacious, and fibrous, 
and covers the other, which is very vascular.* The papilla itself 
is again covered by a part of the internal membrane. The 
follicle, and the papilla, which fills it in a great measure, in- 
crease until the period of ossijical'ion, and then the summit of 
the papilla is of tlie form of the tooth." 

The germ of the tooth being thus formed, we soon discover 
upon the surface of the serous membrane the development of 
a point of ossification which resembles a small osseous shell. 
It commences in the incisoresand cuspidati in one point, in two 
distinct points in the bicuspides, and in the molares in four or 
five, according to the number of tubercles upon their crowns. 

Ossification commences upon each dental pulp of the lower 
jaw a little sooner than upon the corresponding ones of the 
upper, and almost simultaneousl}^ upon corresponding pulps in 
the same jaw. The hard, or ossific part of the tooth, shows 
itself at a period between the third and sixth months, the first, 
which are the incisores, beginning to ossify at about the end of 
the third and fifth months, and the posterior molares at the end 
of the sixth. 

The following, according to Beclard, is the order in which 
the teeth commence to ossify: 1, central incisores; 2, lateral 
incisores; 3, first molares; 4, cuspidati; o, second molares. 
This order, however, is not constant, as the anterior molares 
sometimes take precedence of even the lateral incisores. 

* A variety of opinions is entertained among physiologists upon this point, 

Where the pulp/' says J. Hunter, " is very young, as in the foetus of six 
or seven months, this membrane itself is pretty thick and gelatinous. We 
examine it best in a new-born child, and we find it made up of two lamellce, 
an external and an internal: the external is soft and spongy, without any 
vessels; the other is much firmer and extremely vascular, its vessels coming 
from those that are going to the pulp of the tooth. 

Dr. Blake, on the contrary, does not admit the vascularity of the internal 
lamella, but says that the external is full of vessels." 

" In several preparations, which are minutely injected, taken from the 
human subject, and also from the foetal calf. I have found both the lamell<e to 
be very vascular." — Fox, 



34 



maury's dental art. 



The bony part of the tooth is first formed, and is seen occu- 
pying the summit of the dental papilla, and resembling a small 
cap, single upon the incisores and cuspidati and multiple upon 
the molares. This little cap, which is the form of the free extre- 
mity of the tooth, is the bony larva soon to be covered with 
enamel. It continues to enlarge until it entirely covers the 
papilla. 

*^In teeth in which the papilla is divided, as in the molares," 
adds Beclard, ^'the little bony caps increase in size until their 
borders meet each other, and uniting form one cap having as 
many eminences as the pulp. It also increases in thickness 
interiorly; that is to say upon the side next the papilla, which 
diminishes in proportion to the increased thickness of the cap, 
a phenomenon that has given rise to the opinion that ossification 
results from a transformation of the papilla into bone by a cal- 
careous deposition in its tissue. This is altogether contrary to 
the generally received opinions of modern anatomist's, who be- 
lieve that ossific matter is deposited upon the surface of the 
pulp, and is not a transformation of its tissue. 

As the formation of the ivory of the crown increases, the 
enamel at first forms upon its surface, and then upon the neck 
of the tooth. It presents at first a very thin layer, very in- 
complete, composed of distinct granulations, which afterward 
unite into a rough, pliable layer, which gradually becomes 
smooth, increases in thickness, and becomes extremely hard. 
There are several opinions entertained with regard to the for- 
mation of the enamel. Some have supposed that, like the bone, 
it is deposited by the dental pulp, and that the material of which 
it is formed traverses the bone and transudes through it ; others, 
and they are the more numerous, regard the enamel as deposited 
upon the surface of the bone by either the liquor in which the 
body of the young tooth is bathed, or by the internal mem- 
brane of the capsule. We will add, that the bone of the root 
differs essentially from that of the body of the tooth. 

<^ After the formation of the enamel," says M. J. Cloquet, 
" the tooth increases interiorly by the addition of new bony 
layers. Its cavity elongates and contracts as its walls increase 
in thickness; the root forms itself by gradually encompassing 
the pedicle of the pulp, which soon finds itself enclosed in a 



ANATOMY AND PHYSIOLOGY. S5 

kind of conical tube. When there are to be several roots to 
the tooth, it insensibly separates at its neck into two, three or 
four divisions, according to the number of roots that it is des- 
tined to have, and it is precisely where these divisions occur 
that the base of each root is formed which afterward continues 
to elongate. 

MECHANISM OF THE ERUPTION OF THE TEETH. 

"As the tooth developes itself upon its pulp by the addition 
of new layers upon its internal surface/^ says Beclard, "it 
lengthens, and the top of its crown rises from the bottom of the 
alveolus in order to approach the gums. Its summit soon 
presses against the external membrane of the follicle, which is 
thus ruptured, as also is the gum to which this adheres. An 
absorption is now produced which permits the tooth to escape. 
When the crown has only one point, it makes but a single 
opening, and the eruption of the tooth is aiffected by its enlarge- 
ment: but when it has several points, it forms as many openings 
as there are tubercles, and there remains between these points 
a portion of gum which is finally destroyed. (PI. V. Fig. 4.) 

The dental matrix^ or membranous follicle, continues with the 
tissue of the gums by a narrow canal, and as the tooth rises this 
canal is dilated; but contracts in length, until the tooth appears 
upon the surface of the gums. (PI. IV. Fig. 1.) 

"When the tooth has escaped through the gum, the external 
membrane of the follicles, which has ceased to cover its crown, 
continues to envelop the root, as it unites to the walls of the 
alveolus, forming what is called the ah eolo- dental periosteum. 
This is nothing more than the prolongation of the gum, with 
which it continues to the level of the neck of the tooth." 

The eruption of the teeth takes place at two or three princi- 
pal epochs of life. 

The first, is the eruption of the teeth of children, which are 
twenty in number. It is called ^r^i dentition. The second 
eruption, or second dentition, consists of twenty-eight teeth, 
twenty of which replace those of first dentition, and eight 
make their appearance posterior to the bicuspides; and, finally, 
f?fe wisdom teeth make their appearance. 



36 • maury's dental art. 

*• 

These different eruptions of the teeth present phenomena 
too remarkable not to merit particular consideration, which 
they shall receive when we shall have pointed out the nerves, 
arteries, and veins which form a part of the dental organs 
proper, and the numerous anomalies that the teeth present in 
their number, position, structure, &c. &c. 

The nerves of the teeth are branches of the fifth pair, or 
trigeminus. The superior teeth receive their branches from 
the second branch (superior maxillary:) this nerve, as is known, 
before entering the sub-orbital canal, gives off two branches, 
called the posterior dentals. The first, or the internal, gives off 
a twig, which, running into a canal in the wall of the maxillary 
sinus, communicates with the dental, and the other pierces the 
substance of the bone to reach the roots of the three molares. 
The 'posterior external dental is sometimes distributed to these 
roots, after having pierced their alveoli. This same superior 
maxillary nerve, after having traversed the sub-orbital canal, 
gives off, near its external orifice, the anterior dental nerve, 
which, after passing along the groove of the maxillary sinus, 
communicates with a branch of the posterior dental, and is dis- 
tributed to the bicuspides, cuspidati, and incisores. 

The inferior teeth receive their sensibility from the inferior 
maxillary, the third branch of the trigeminus. After having 
supplied the neighbouring muscles and the tongue with nervous 
fillets, this branch penetrates the canal of the inferior jaw, and 
gives off twigs to all the teeth. Under the first bicuspides, a 
branch of this nerve escapes outward through the anterior 
mental foramen, to be distributed to the inferiorlip. (PI. I. Fig. 2.) 

The arteries of the teeth follow the course of the nerves. 
The superior are branches of the alveolo sub-orbital; and the 
inferior are derived from the internal maxillary. They conse- 
quently have their origin from the external carotid. It has 
been ascertained that the inferior dental artery has three divi- 
sions ; one, near the inferior border of the bone, appears to be 
the vessel that nourishes it ; the others are distributed to the 
pulps of the teeth of first and second dentition. (Plate II. Fig. 
2,) and (Plate YI. Fig. 3.) 

The veins of the teeth follow the course of the arteries. 
The inferior has its own canal, under that of the artery. (PMe 



ANATOMY AND PHYSIOLOGY. 



37 



IL Figs. 1 and 2,) As to the anomalies that are met with in 
the teeth of the human subject, they, as well as their varieties 
are very numerous. (PI. VIII. Figs, from 1 to 23.) 

Varieties of J^umher, — The circumstances under which, by an 
unnatural development, more than sixteen teeth are sometimes 
seen in each jaw, are very rare. It more frequently happens 
that this number is incomplete. Some persons, particularly 
women, never cut their wisdom teeth. At other times they 
have a supernumerary molar, or incisor, but this is still more 
unfrequent. (PI. IX. Fig. 9,) and (Plate X. Fig. 1.) 

Varities of Form. — The superior incisor teeth are sometimes 
bent in the form of a bayonet; (PI. IX. Fig. 10;) and some- 
times they have double roots. At other times teeth are met 
with of an unnaturally large size, (PI. VIII. Figs. 3, 20, 22, 23.) 

Varieties of Position. — The annals of medicine have fur- 
nished us with remarkable examples of this species of anomaly. 
In fact, teeth have been met with situated transversely in their 
sockets, others piercing the alveolar border or the palatine 
arch. They are sometimes developed in the very substance 
of the maxillary bone above the palate (PI. XIII. Fig. 12,) 
and even in the pharynx. Albinus speaks of two extremely 
large and long teeth that were concealed in the bodies of the 
nasal apophyses of the superior maxillary bones, with their 
crowns pointing upward and their roots downward. The ana- 
tomical cabinet of the Faculty of Medicine in Paris contains a 
somewhat similar specimen. This truly curious and unique 
case, was furnished by Professor Marjolin. It is carefully 
preserved, and displays two supernumerary incisores situated 
in the substance of the base of the maxillary bone. The bodies 
of these two teeth were inverted, and the root of the right 
central incisor presented the form of a bayonet. (PI. IX. Figs. 
1,2, 3, 4.) 

M. Dentz, dentist to the King of Holland, sent us from Am- 
sterdam several teeth which present very remarkable anomalies. 
Among these different pathological specimens was a superior 
jaw, in which the right central incisor pointed toward the 
wings of the nose. (PI. IX. Fig. 5.) 

Varieties of Structure and Consistency. — These are gen-erally 
4 



38 



maury's dental art. 



very numerous and nearly always dependent upon morbid 
causes. (PI. XIl. Figs. 16 to 21.) 

Uses of the Teeth. — The teeth, in a healthy state, possess a 
hardness far greater than other bones of the body; they contri- 
bute, each one respectively, to mastication, each class having 
its peculiar office in this process; they are necessary in the 
operation of perfect digestion; they assist in the articulation of 
words; and they are ornamental. Man possesses the most 
beautiful and regularly arranged denture of all animals. 

Now that we have terminated our general remarks upon the 
teeth, and briefly pointed out their structure, mode of develop- 
ment, mechanism of eruption and use, we shall briefly review 
the different phenomena that accompany their emancipation 
from the alveoli. 



MECHANISM OF THE ERUPTION OF THE TEETH OF FIRST 
DENTITION. 

Although at birth, and some months after, the teeth are not 
visible, their formation has commenced some time previously. 
(PI. v. Fig. 1.) 

The germs of the deciduous teeth," says the learned ana- 
tomist heretofore quoted, "exist in the foetus of two months' 
gestation. They commence, to ossify about four and a half 
months after conception, or the middle of gestation. Ossifica- 
tion first commences upon the inferior incisores, and then upon 
the superior; afterward upon the cuspidati and raolares, follow- 
ing the order of their eruption. 

"Though the teeth are far advanced at birth, they are 
enclosed in their alveoli and covered by the gums. It is very 
rare that any of the teeth have protruded through the gums at 
this period ; it is generally not until the sixth or eighth month 
that they commence to appear. (PI. V. Fig. 2.) 

Until the fourth month of birth, the jaws, and the compact 
tissue which covers them, experience no change; but in pro- 
portion as their organization progresses, their changes are more 
obvious. The alveoli are prolonged ; the hony borders of which 



ANATOMY AND PHYSIOLOGY. 



39 



they are constituted enlarge and keep pace in height with 
their increasing diameter. The tooth acquiring greater di- 
mensions, can no longer be retained in its socket, and hence 
rises and perforates the alveolar portion of the membrane, the 
pulpous tissue which constitutes the gum, and the mucous 
membrane that covers them.'' At this epoch, it is vulgarly- 
said that the child cuts its teeth. The expression is highly 
improper, as it is always the teeth that cut the gums. " This 
perforation," says M, J. Cloquet, " is ordinarily effected with 
difficulty, because that triple layer is gradually thinned as the 
tooth advances. The tooth having escaped, the membranous 
tissues continue to unite to each other by their borders adhe- 
ring together at its neck, .and forming a circular pad which 
adds to its solidity. 

The age at which the eruption of the teeth of children begins 
as variable. Cases are related of children having one or two 
of their teeth at birth; they sometimes are one or two years 
old before any of them make their appearance. I had und^er 
my care in Bagneres, in 1810, a young girl, aged seven years, 
whose inferior ineisores had never appeared; the space left for 
them was wide enough for three teeth, and the alveolar border, 
at this point, was very low and narrow. 

The eruption of the teeth of first dentition is gradual, and 
they generally appear in pairs, a longer or shorter time elap- 
sing between the eruption of each pair. Tiie two inferior 
central ineisores appear first; about two months after the two 
superior central ineisores ; then the inferior and superior lateral 
ineisores appear in about an equal space of time. Some months 
later the inferior, and then the superior cuspidati make their 
appearance through the gums. It often happens that the 
cuspidati do not appear until after the first molares, or at the 
same time with them. Finally, usually from two years and a 
half to three and a half, we discover the second molares. 
First dentition is then completed, and the child possesses the 
twenty teeth of which we have spoken in treating of the teeth 
in general. (PI. V. Figs. 2, 3, 4, 5, 6.) It may be concluded 
from what we have said, that the teeth of first dentition appear 
in the following order, at the different epochs annexed. 



40 



maury's dental art. 



The four cent?al incisores, the inferior appearing first, 

al from 5 to 10 months of age. 
The four lateral incisores, " 9 to 16 " " 

The four cuspidati, " 14 to 23 " " 

The four first molares, " 20 to 31 « " 

The four last molares, " 27 to 40 « " 

The above is the order in which teeth of first dentition 
usually appear, but we repeat that it is liable to variations. 



MECHANISM OF THE ERUPTION OF THE TEETH OF REPLACE- 
MENT, OR SECOND DENTITION. 

In second dentition thirty-two permanent teeth appear in 
the jaws, of which twenty are called teeth of replacement, be- 
cause they replace those that have been shed, and twelve 
are new. 

" The germs of the teeth of the second denture,^' says M . 
J. Cloquet, are visible in the foetus of three or four months' 
gestation. Those of the twenty teeth of replacement are placed 
behind the follicles of first dentition, and the remaining twelve 
are situated posteriorly in the substance of the jaw.'' 

The germs of both dentures are included in the same cavi- 
ties of the jaws, before the formation of the walls of the alveoli. 
When these partitions, at first membranous, commence to 
ossify, distinct osseous cells are formed for each class of folli- 
cles, which are thus formed, occupying separate cavities. The 
dental vessels nourish both classes of follicles. Dr. Rousseau, 
who had charge of the anatomical works of the National His- 
torical Museum of Paris, has endeavoured several times to 
discover the dental follicles of which we speak. This able 
anatomist has instituted for this purpose the most minute 
investigations; and although on account of the extreme tenuity 
of these follicles he was not able to discover them, he never- 
theless with M. J. Cloquet, admits their existence. 

''The germs of second, like those of the first dentition? 
adhere to the gums by a full or canaliculated elongation, which 
is simply the dental canal, or the appendage of the membrane 
of the follicle. (PI. IV. Fig. 1.) This canal, in order to 
reach the gum, passes through a little opening that is seen in 



ANATOMY AND PHYSIOLOGY. 



41 



the maxillary bone, behind each deciduous tooth, upon the 
posterior part of the alveolar border. These small openings 
are very perceptible at the level of the incisores and cuspidati. 

^'As the teeth of second dentition advance, those of the first 
denture become loose, detach themselves or drop out sponta- 
neously, almost entirely deprived of their roots ; but if they 
are extracted as soon as they become loose, a great portion of 
their roots will still be found unabsorbed. 

When we examine the cause of these phenomena with atten- 
tion, we observe that the teeth of second dentition are placed 
below and behind the alveoli of those of the first denture. 
(PI. V. Figs. 4, 5, 6.) In advancing, they press against the 
posterior walls of the alveoli of the deciduous teeth ; this pres- 
sure at first occasions a thinning of th<e walls, and afterward 
the perforation of the osseous partition. The permanent teeth 
gradually introduce themselves into the alveoli of the decidu- 
ous teeth through the opening, and soon cause atrophy of their 
vessels and absorption of their roots. 

The absorption of the partition of the alveoli and of the 
roots of the perishable teeth, does not appear to be occasioned 
by the simple pressure exercised by the permanentes. The 
generality of anatomists admit, with Bourdet, Laforgue, and 
others, that the absorption is effected by a vascular organ, a 
kind of absorbent apparel that covers the crown of the teeth of 
second dentition. It is a species of fleshy bud, or of red vas- 
cular membrane, which is placed between the crowns of the 
permanent and the roots of the deciduous teeth, in such a man- 
ner as to prevent their immediate contact. 

The following is the order in which the permanent teeth 
appear through the gums^ — 

About the seventh year, the first molar appears, at the 
posterior part of the jaws. (PI. VI. Fig. 2.) The deciduous 
teeth commence at the same time to loosen and drop out, gene- 
rally between the sixth and eighth years, in the order of their 
eruption. (PI. VI. Fig. 1.) The incisores and cuspidati of the 
superior and inferior jaws are successively replaced by teeth 
similar to themselves. The two molares drop out, and are 
replaced by the two bicuspides. From about the eleventh to 
the thirteenth year the second bicuspides appear, one on each 

4 * 



42 



maury's dental art. 



side, behind the first. From the twelfth to the fourteenth 
year the second molares appear. The mouth is then provided 
with twenty-eight teeth. 

We have subjoined the following table, by which we can, at 
a glance, discover the different periods at which the teeth of 
the second denture make their appearance. 



from 6 to 8 years. 



The four first molares, and 
The two inferior central incisores, 

The two superior central incisores, " 7 to 9 " 

The four lateral incisores, " 8 to 10 " 

The four first bicuspides, " 9 to 11 " 

The four cuspidati, " 10 to 12 " 

The four second bicuspides, 11 to 13 " 

The four second molares, " 12 to 14 " 

Hence it is not until the twelfth or fourteenth year that 
second dentition is completed. Finally, from the eighteenth 
to the thirtieth year, and sometimes at a later period, the four 
last molares, commonly called the wisdom teeth, make their 
appearance through the gums. (PI. VI. Fig. 3.) 

These last, as we have seen, do not make their appearance at 
periods as uniform as the others, but generally between the 
twenty-third and twenty-fifth years. Very often two only are 
cut; sometimes only one; and sometimes they are never cut. 
This often happens among women, and may depend upon the 
maxillary bones being shorter in them than in men ; or it may 
be occasioned by a mal-position of the tooth. These teeth are not 
very regular: they present two or three very short roots, united 
to one another, and permit only half their crowns to be visible. 
Sometimes they crowd upon the preceding tooth, and at other 
times are thrown out of the arch. They are often of an unna- 
turally small size, but sometimes are extremely large ; and at 
times have strange forms. (PL VIII. Figs. 2, 3, 23.) M. Du- 
moutier, Assistant Anatomist in the Medical School of Paris, 
presented us with a superior jaw, in which there were two 
wisdom teeth placed the one above the other. (PI. X. Fig. 1.) 
Our friend. Dr. Tesse, dentist in Douai, sent us a wisdom tooth 
of late growth, having two crowns united, and but one small 
root. (PI. VIII. Fig. 7.) We will return to this subject of 
anomalies of the teeth in treating of irregularities. 

It vvill be perceived, from what we have said, that there are, 



ANATOMY AND PHYSIOLOGY. 



43 



for all the teeth, fifty-two germs; twenty for the teeth of the 
first denture, and thirty-two for those of the second. 

When the process of first dentition is going on, the alveolar 
arches are but partially developed. The deciduous teeth are at 
first crowded together; but the branches of the jaws continue 
to elongate, and at the period of second dentition, as they are 
much enlarged, these teeth are found remote from each other. 
The maxillary bones have then increased in depth and dia- 
meter; but as the permanent incisores are very large, they gene- 
rally force the cuspidati out to occupy places anterior to them. 
The branches of the jaws continuing to increase at a later 
period and the two bicuspides being smaller than the two mo- 
lares that preceded them, there is sufficient space for them, and 
these teeth arrange themselves regularly in the alveolar arches. 
(PI. VII. Figs. 4, 5, 9, 10, 14, 15, 22, 23.) 

" As the teeth are emancipated from the gums, the space be- 
tween the two jaws increases and the face requires greater di- 
mensions in its vertical direction. The branches of the 
maxillary bones are redressed, their angles become more pro- 
minent, and the maxillary tuberosity sinks down after the eman- 
cipation of the w^isdom. tooth. (PI. VI. Fig. 3.) 

"When all the teeth have appeared, the two arches form by 
their reunion a paraboloid figure. The superior is wider than 
the inferior, which it overlaps when the jaws are approximated. 
The free border or edge of the dental arch is undulated. It is 
uniform in the anterior part, which is formed by the incisores 
and cuspidati; posteriorly it presents two rows of eminences, in 
consequence of the largeness of the molares and the arrange- 
ment of their tubercles. With regard to these eminences the 
external is sharper than the internal, in the superior jaw. The 
contrary is the case in the inferior.'^ (J. Cloquet, Anatomy of 
Man.) 

The only appreciable changes that the teeth undergo after 
their complete formation, are the ossification of the pulp or pa- 
pilla that fills their cavities, and which, when ossifying, con- 
tracts a little; and the gradual wearing down of their crowns. 

The teeth, after having been worn down more or less, 
whether they experienced accidents and vicissitudes or not, often 
drop out before old age. The dental vessels and nerves finally 



44 



maury's dentAl art. 



become obliterated, and the opening of the dental canal closes. 
The teeth may then be regarded as bodies foreign to the alveoli 
that contain them. The walls of these cavities contract imper- 
ceptibly upon the roots of the teeth and gradually expel them. 

When all the teeth have been lost, the inferior jaw no longer 
retains its position, but naturally approaches the superior, and 
is carried farther forward and upward, so that the face becomes 
shorter and the chin more prominent. This gives a peculiar 
appearance to the physiognomy of old persons. The alveolar 
border, thus deprived of teeth, undergoes remarkable changes. 
The bottom of the sockets fill up, their walls approximate, the 
alveoli finally disappear entirely, and the dental border presents 
only a flattened surface. (PI. VI. Fig. 4.) The gums gradually 
acquire a great degree of firmness, and perform, though with 
more difficulty, the important functions of the teeth, considered 
as the principal agents in mastication. 

FIRST AND SECOND DENTITION, AND THE MEANS OP PREVENT- 
ING EVILS THAT MAY RESULT THEREFROM, 

The evils that generally accompany first dentition are very 
numerous, and it may be truly said that, from the formation of 
the first rudiment of the dental pulp until the completion of 
the teeth of first and second dentition, nature is continually at 
work. Dentition, however, is not a disease, though it often 
disposes the subject to a number of certain morbid afiections; 
but this operation of nature, remarkable for its process of ossi- 
fication, is sometimes critical to children. During the first two 
or three years this operation is wonderful, and the morbid phe- 
nomena that then present themselves, are necessarily in propor- 
tion to the difficulty that the teeth experienced in rising from 
their alveoli. Sometimes indeed dentition is so calm and easy, 
that it is not perceptible. This happens generally among 
children of strong constitution. At other times, on the con- 
trary, it is very laborious, and is accompanied by maladies that 
dispel all hope of the recovery of the child. 

Among the diseases that present themselves at this period, 
some appertain to the local efi'orts of dentition and are precur- 
sors of this process. They are salivation, or ptyalism, inflam- 



ANATOMY AND PHYSIOLOGY. 



45 



matory swelling and pain in the gums, aphthae, or certain 
inflammations of the lining membrane of the mouth. The 
others may be considered as purely sympathetic affections' 
They are convulsions, vomiting, diarrhoea, cutaneous eruptions, 
&c. &c. After what has been stated, it may be inferred that 
the emancipation of the deciduous teeth is more or less serious 
according to the extent of the disorders attendant upon it. 

The appearance of the deciduous teeth is generally manifest- 
ed by a slight heat in the gums, a greater flow than usual of the 
saliva, and an irritation somewhat painful, that causes the child 
to put his finger or any thing that he may happen to have in 
his hand, into his mouth. The circular border of the gum 
flattens, and the nose is often the seat of a very troublesome 
itching sensation, which produces frequent sneezes: alvine de- 
jections are more or less abundant, and an increased flow of 
urine supervenes. The motions of the child are rapid, and it 
manifests great impatience and fretfulness; is agitated during 
sleep, and frequently starts with loud and plaintive shrieks. 
The part of the gum through which the tooth is about making 
its way is swollen, becomes red, smooth, and distended, and 
finally becomes white as the tooth approaches its surface. This 
species of tumefaction is sometimes circumscribed, but when 
several teeth are making their appearance at the same time it 
is often extended over the whole jaw. The slightest pressure 
upon the gums of the child now creates pain; but the tooth 
does not long delay coming forth, and so vanishes all sufiering. 

Thus far, this is the natural process; but these symptoms, 
which present nothing alarming, are not always so favourable. 

When dentition is difficult, new derangements are experi- 
enced between the fourth and the eighth months, and they 
portend the disorders that may accompany them. Digestion is 
impaired; the child becomes fretful; his nervous susceptibility is 
increased; the milk that is given as his nourishment is readily 
thrown up; he is troubled with a serous, yellow, or green 
diarrhoea, or an obstinate constipation; the flow of saliva be- 
comes more abundant; the gums are extremely sensitive and 
much tumefied; and there is an engorgement of the parotid and 
other salivary glands. Sometimes there will be paralysis of 
the inferior extremities; convulsions often manifest themselves 



46 



3IATjry's dental art. 



successively in several parts of the body. Such symptoms are 
always serious, and appear to be produced by the darting pains in 
the nervous fibres of the periosteum and gums. There is fre- 
quently fever, agitation, groaning, fright, delirium, &c.; and, if 
prompt relief is not obtained, it is seldom that the child survives 
a series of phenomena so alarming. We shall treat more par- 
ticularly of several of these evils, and although their treatment 
comes under the province of the medical practicien, we shall 
point out, in a brief manner, the course that should be pursued 
under such circumstances. 

Salivation^ or Ptyalism. — Salivation, which ranks first among 
the local affections of first dentition, so far from being a symptom 
that should be feared, is, on the contrary, a natural and very 
salutary effect of dentition; and, if it becomes injurious, it is 
only from its length and intensity. As it tends to favour the 
suppleness and the dilatation of the gums, and to prevent pain 
and inflammation of these parts, we should endeavour to pre- 
serve and excite it whenever it may be suppressed by any 
cause; for the instant it is suppressed, the sufferings of the 
child become greater, and sometimes the result has been the 
engorgement of the sub-maxillary glands. It is proper, in such 
cases, to use slight frictions upon the gums of the little patient 
when his sufferings increase: it even appears that this pleases 
him, since it often is sufiicient to prevent his crying, and dis- 
pels the troublesome itch created in the gums. These frictions 
should be made with mucilages of marsh-mallow, or gum Arabic 
sweetened with honey or sirup. The parts that are painful 
should be rubbed, either with the finger or a thin piece of 
marsh-mallow root, or with fine linen soaked in honey. Large 
figs, cooked in milk, or mashed between the fingers, are also 
appropriate. 

But if friction upon the gums of children be not hurtful to 
them, it is not so with the pressure sometimes applied to these 
parts, by means of hard and polished bodies, to facilitate the 
exit of the teeth, under the erroneous idea that these little 
bones, in coming through the gums, mechanically pierce them: 
hence the inconsiderate use of corals, or other hard bodies, 
that are put into the mouths of children to soften their gums. 



ANATOMY AND PHYSIOLOGY. 



47 



They are useless, even though they should not occasion any 
injurious effects; but the gums are hardened by the irritation 
thus produced by continued friction: and so far from diminish- 
ing, by their use, the evils that we wish to prevent, they only 
augment them. The parts becoming more irritable, the ner- 
vous system participates in the local affection, and many diseases 
common at this period of life are thus excited. 

When the child appears desirous of biting something, if we 
wish to employ friction, we can substitute for the hard bodies 
of which we have spoken a crust of bread, root of boiled marsh- 
mallow, piece of liquorice wrapped in fine linen and dipped 
into a strong decoction of barley-water, sweetened and aroma- 
tised with a few drops of the - flowers of orange, or any other 
liquid. This, by relaxing and softening the tissues of the gums, 
diminishes the irritation. This mode of friction occasions none 
of those inconveniences which are ordinarily produced by those 
composed of harder bodies. 

The flow of saliva may still be kept up by keeping the child 
warm, and moistening his mouth with mucilaginous drinks. It 
may also be increased by using upon the sides of the mouth 
fomentations, with decoctions of marsh-mallow. 

M. BoUet, an accoucheur, advises, under such circumstances, 
to place upon the child sleeves of prepared flannel, to be worn 
from birth to the fourth or fifth year of age. These sleeves, 
sewed together to a border of the same material, cover the 
shoulders and reach as far as the fore-arm. We have several 
times advised the employment of these, and discovered that 
their efficacy depended entirely upon the quantity of perspira- 
tion excited in the parts with which they were in contact. 
This is a proper means to favour the disgorgement of the sali- 
vary glands: it is also for the accomplishment of the same end 
that we advise warm baths.* 

* A writer in the Cyclopedia of Practical Medicine observes: '* The injury 
which the constant use of these sweet and stimulant ingredients must do to 
the stomach, renders their employment very objectionable. 

"The management of infants during teething when the process is going 
on in a favourable manner, is very simple, and rarely calls for the interference 
of the physician. The child should be much in the open air, and well exer- 
cised, and the bowels kept free. The employment of the cold bath or cold 
sponging daily, followed by gentl« friction over the surface of the body, is 



48 



matjry's dextal art. 



Inflammatory Swelling and Pain in the Glands. — The tissue 
of the gums at the period of dentition is often very tender, 
of a livid red, or nearly violet colour, dry, shining and very 
painful to the touch. These swellings are then accompanied 
with redness and burning heat of the cheeks, tumefaction of 
the face, and great thirst. The child is also affected with drow- 
siness, and is interrupted in its sleep by agitated movements 
and repeated cries. — Fever supervenes, which is continued or 
intermittent, and which has received the name of fever of 
dentition. 

Although this phlogosis of the gums is considered only a 
local aflfection, it is nevertheless true that the digestive organs 
generally sympathize with it. In fact, in a very short time, 
the general health becomes sensibly impaired; and if we have 
not recourse to proper treatment, the little patient may be ex- 
posed to great danger; as that which was considered only a 
local affection soon becomes a constitutional disease very diffi- 
cult to cure. 

Under such circumstances, it is proper to administer soothing 
lotions to the child, or to the nurse, if the child has not been 
weaned. If these prove insufficient to keep the bowels open, 
we should have recourse to clysters and laxative drinks, such 
as whey, water sweetened with honey, decoction of prunes, 
&c. We should also persist in the use of derivatives, which 
will diminish the cerebral congestion and prevent convulsions 
or drowsiness. Pediluviums, simple or compound, and cata- 
plasms, emollient or slightly stimulating, placed upon the in- 
ferior extremities, and, above all, the application of two or 
three leeches behind the ears, according to the age of the child, 
are the means that are highly useful under such circumstances. 
If the painful swelling of the face does not diminish, and if the 
part continues red and distended, and has the appearance of 
being elevated by the crown of the tooth, it is then expedient 
to have recourse to incision of the gums. The pain and ge- 

very useful; and all means should be taken to support the tone of the system 
at a just medium. The breast should be given to it often, but not long at a 
time, and thus the attendant thirst will be quenched and the gums kept moist 
and relaxed, and their irritation soothed, without the stomach being over- 
loaded. The health and diet of the nurse should at this period be particularly 
attended to, and all stimulant food and drinks avoided." — S. 



ANATOMY AND PHYSIOLOGY. 



49 



neral swelling, after this operation, is often known to disappear 
as if by enchantment. In some cases, however, it contributes 
to augment the nervous symptoms, by the irritation which it 
produces in the parts, the sensibility of which has already been 
very much increased by the efforts of dentition. 

This operation, so useful in many cases, should not, as is often 
the case, be practised without judgment, lest the dental capsule 
be opened before the tooth has sufficiently advanced in ossifi- 
cation. It is absolutely useless during the eruption of the in- 
cisores, but very proper when the molares are about making 
their appearance through the gums; as these teeth, on account 
of their tubercles, and the size of their crowns, meet with more 
resistance from the tissue of the gums. When the tooth is 
nearly through, and the gums are distended so as to assume a 
white colour, the operation may be performed without any 
inconvenience, since it assists the tooth in surmounting the re- 
sistance of the soft parts that surround it. 

This operation is performed with a very small lancet blade, 
a little curved, mounted and fixed with a spring upon a steel 
shank, and adapted to a handle, (PI. XIV. Fig. 4,) or with a 
flat hook having two cutting sides. An assistant holds the 
head of the child; his mouth is kept open with the left hand 
of the operator, who with his right introduces the first men- 
tioned instrument between the cheeks and gums; he plunges it 
horizontally in the external side of the gum, and describing a 
semicircle, elevates the flap of gum that may prevent the 
eruption of the tooth. The flat hook which we mentioned, 
is so constructed as to be introduced into the mouth without 
any fear of injuring the child. This instrument may serve to 
cut away a portion of the gum.* 

* The operation of lancing the gums in dentition is one that cannot be too 
strongly recommended; its beneficial effects are observed after all other means 
have failed. "There exists much causeless opposition to this practice, and 
the objections of its opponents, though they have been shown to be ground- 
less, are again and again reiterated, and, to one unacquainted with the subject, 
not without some seeming plausibility." 

'* By some it is objected, that, though the opening of the gum may afford 
temporary relief, yet the cicatrix, formed by the healing of the wound, forms 
a greater obstacle to the exit of the tooth, than the parts, when left to them- 
selves, ever do. Now, any one who is at all conversant with the subject, 
knows, that in four cases out of five, where the operation is necessary, the 
5 



50 



maury's dental art. 



This mode of operating is preferable to the longitudinal in- 
cision, which is very painful, and requires frequent repetition. 

We shall novv point out the means necessary to subdue the 
principal sympathetic disorders which depend upon first den- 
tition. 

Convulsions. — Some children, during dentition, are almost 
constantly affected with spasms, which are preceded by a sort 
of general irritation and frequent tremours of the limbs. The 
pain becoming more intense, produces slight convulsions, which, 
in very nervous children, may be repeated, prolonged, and be- 
come so violent, as to produce death. Children most subject 
to these nervous affections, are usually thin, of feeble, excitable, 
or sickly parents. Fat, fresh, rosy, strong, and vigorous chil- 
dren, are also liable to convulsions; and it is observed that this 
happens most frequently during theerruption of the molares. 

These convulsions may be more or less extended; sometimes 
they are confined to the muscles of the eyes and face ; at other 
limes they extend to the superior, but rarely to the inferior 
extremities. Sometimes they are transient, and the child 
quickly recovers the use of his limbs; and again the paroxysm 
may be prolonged for a considerable period. 

teeth are so far advanced, that on the collapsing of the edges of the wound, 
their crowns immediately protrude; and even when the wound does unite, 
the soft and spongy cicatrix much more readily jdelds to the action of the 
absorbents, than the unpunctured gum ever would have done." 

" Another objection is founded upon a supposition that the enamel, at this 
period, is in a soft and amorphous state, and that, consequently, the teeth may 
be injured by contact with the knife. But as the parts of the enamel that 
are exposed to the instrument usually attain their hardness before this opera- 
tion is required, this objection is without foundation. In short, I have never 
known any injury to result from it, either in my own practice, or in that of 
others; nor can those that are opposed to it bring facts to support their op- 
position. 

" This practice often succeeds after all others have failed. I have frequently 
known children, after having suffered the greatest agony for days and weeks, 
until they were reduced to mere skeletons, to obtain immediate relief with- 
out the aid of any other remedy than this, which at once removes the cause; 
whereas, the others only counteract the effects of suffering, and can, there- 
fore, only be considered as palliatives, that may assist nature in her struggle 
with disease, but cannot always prevent her from sinking in the contest." 
(Professor C. .d. Harris' Denial £rt.)—S. 



ANATOMY AND PHYSIOLOGY. 



51 



In other respects the treatment of the sympathetic convul- 
sions of dentition differs but little from that applicable to con- 
vulsions from otlier causes, and should be treated according to 
the state of the child's system; but generally they terminate 
the instant the teeth appear through the gums. During the 
paroxysm, we should make use of such remedies as have a 
direct influence over it. Thus we should give the child fresh 
air, put salt into its mouth, apply cold water to its face and 
forehead, and immerse its hands or feet in water warmed or 
slightly stimulating. 

When there is fever, and manifest symptoms of plethora, a 
leech should be applied behind each ear. or at the angles of the 
jaws. As regards anti-spasmodics, such as the water of the 
flowers of orange, ether, camphor, opium, &:c., they are all 
useful for children of feeble constitution. 

We shall say but a few words upon the popular use of col- 
lars of amber, the grains of paeony, the root of valerian, the 
heads of vipers, or any similar charms accredited by the igno- 
rant and credulous. These are incapable of injury, and as 
their employment may, under such circumstances, calm the 
restless imagination of some mothers, their use may be allowed 
without inconvenience. 

Diarrhcea, accompanied by Vomiting. — We cannot pay too 
much attention to the vomiting and diarrhoea that take place 
during dentition; they are sometimes the precursors of serious 
diseases of the brain and abdominal organs. ^' Diarrhoea occurs 
sometimes alone; but oftener vomiting accompanies it or 
prom.ptly succeeds it in such manner, that in most cases the 
one may be regarded as only the first stage of the other/^ — 
{Guersent, Diet, de Mtd.) These two principal symptoms 
united, constitute a particular disease, w^hich is especially ob- 
servable among children, from the third or fourth month until 
the end of first dentition, and, which is much more frequent 
during the emancipation of the euspidati, bicuspides and 
molares. It is met with in every class of society; and is 
believed to be more prevalent among infants who have been 
weaned very early, or whose regimen has been badly directed. 

In the first stase of this disease the diarrhoea is extremely 



52 



maury's dental art. 



abundant, serous, yellow, or oftener greenish. It is sometimes 
inodorous, at other times it is fetid; the abdomen is distended, 
round and sonorous, and the child is sad, dejected, and fretful. 
The preceding symptoms are accompanied by vomiting, at 
first serous and transparent, and afterwards greenish, which is 
nearly always preceded by a slight dry cough. At this period 
the eyes are encircled, sunken, and somewhat dimmed, and 
have a heavy appearance ; the febrile exacerbations, more or 
less observable, are irregular; the green vomiting and intestinal 
evacuations become still more abundant at this stage of the 
disease, and afterward diminish. As the disease progresses, 
the debility and emaciation become great, and the child dies of 
convulsions, preserving nearly always its consciousness to the 
last moment of its existence. 

^'The course of the disease sometimes varies: the intervals 
between the vomitings are often long, which is a favourable 
sign. In some cases the diarrhoea precedes the vomiting 
several days, or even a week ; at other times, the vomiting and 
diarrhoea supervene nearly at the same time, and the child 
perishes in the course of three or four days." — {Guersent.) 

In the first stage of this afiection, the longest duration of 
which is from thirty to forty days, light diet, soothing and 
mucilaginous drinks, injections, fomentalions, and emollient 
cataplasms, will be sufficient to arrest the violence of the symp- 
toms: the same mode of treatment is employed with advantage 
in the second stage, by combining with them baths, opiate 
injections, and also emollient vapours to the abdomen, or appli- 
cation of laudanum to the same part. In serious cases, that is, 
when there exists manifest prostration of the vital energies, it 
is necessary to use sinapisms and blisters upon the extremities, 
nape of the neck, and even upon the abdomen if the alarming 
symptoms are not promptly alleviated. 

Constipation. — Constipation is a very serious symptom during 
dentition. New and serous milk of a healthy nurse is at first 
the best remedy. Tepid baths answer a good purpose, when 
there is heat in the primse vise; and we may, without inconve- 
nience, excite evacuations with mild purgatives, such as an 



ANATOMY AND PHYSIOLOGY. 



53 



infusion of one drachm of senna in the juice of prunes sweet- 
ened with sugar or honey. 

If there is painful tension of the abdomen, or constipation, 
soothing injections are indicated, and also emollient fomenta- 
tions to the part. 

Cutaneous eruptions that occur during dentition require no 
particular treatment ; they disappear on the protrusion of the 
tooth through the gums; these eruptions consist of little scaly 
tetters that have their seat upon the face or behind the ears. 
We, however, should not confound them with erysipelatous 
erythema, and which is nearly alwa3's the result of the bad 
management of the child by its nurse. 

SECOND DENTITION, AND THE EVILS THAT ACCOMPANY IT. 

The evils that present themselves during the second, are not 
SO serious as those that accompany the first, dentition. As to 
the sympathetic aiOfections to which children are mostly dis- 
posed at the epoch of second dentition, which comprises the 
removal of the twenty deciduous teeth, their replacement by 
the permanent, and, according to our division, the eruption of 
the four molares, are congestions, nasal hemorrhages, a mucous 
and sometimes sanguineous ptyalism, engorgement of the 
glands, diseases of the eyes and ears, scaly eruptions, and fari- 
naceous tetters of the face, which disappear as promptly as they 
appear; but they at this period do not experience catarrh, and 
inflammatory serous diarrhoea. 

The molting of the temporary teeth, which precede second 
dentition, scarcely ever occasions any sensible disturbance in 
the economy. It has, however, been noticed that this second- 
ary process appears to favour the development of scrofula and 
rachitis, and, it is rare that it is not accompanied by local or 
general evils, which are always proportioned to the tempera- 
ment, strength, or feebleness of the child. 

In proportion as the teeth of second dentition are developed, 
the roots of the deciduous teeth, and often the interior of their 
crowns, are found to be destroyed; and, as there is no trace of 

5* 



54 



Maury's dental art. 



the roots left, it is presumed that they are gradually decom- 
posedj and, assuming a fluid consistency, are afterward taken 
into the general circulation. The absorption of the temporary 
roots is a curious process in the development of second denti- 
tion. It sometimes commences at the point, and progresses to 
the neck of the tooth, which, becoming loose, falls out, or may 
be easily taken from its socket, to which it is very slightly 
attached, since, in most cases, the fingers are sufficient for its 
extraction. 

There are circumstances under which nature deviates from 
her usual course. These are, for example, when the roots of 
the temporaries, not having been destroyed, the permanentes 
are turned from their natural situations. This occasions irregu- 
larities in the dental arch, which it would always be easy to 
avoid if the injudicious tenderness of parents did not cause the 
operation to be too long delayed; being in hopes, from day to 
day, that the tooth will drop out, they thus allow the perma- 
nent tooth to deviate from its place in such manner that it is 
difficult to replace it. In such a case, we should explain to the 
parents of the child that there is no danger, and b}^ means of a 
simple operation, timely performed, serious consequences will 
be prevented. We should then extract the temporary teeth, 
one after another, to bring the permanentes into their proper 
places. 

This operation is not only necessary in order to prevent 
evils that may arise without it, but in some measure becomes 
indispensable to obtain a regular arrangement of the permanent 
teeth, which may always be accomplished by care being taken 
to make sufficient room for their convenient arrangement. As 
some children loose their teeth sooner than others, frequent 
examinations of their mouths should be made; and when the 
temporary teeth commence to be loosened, we should still con- 
tinue our examinations; for no period of life demands more 
attention than that of the replacement of the deciduous teeth. 



ANATOMY AND PHYSIOLOGY. 



55 



THE EVILS THAT ACCOMPANY THE ERUPTION OF THE THIRD 
MOLAR TEETH. 

Adults are sometimes not more exempted than children from 
the serious evils of dentition. These often manifest them- 
selves during the eruption of the third molares or wisdom 
teeth: evils which more particularly happen when the other 
teeth are very close, as there is but little space between the 
coronoid apophysis and the second molar. 

It often happens that these teeth are cut without the con- 
sciousness of the patient; but it is not always the case, and their 
eruption sometimes produces evils more or less serious. These 
appear to depend upon the thickness of the osseous substance, 
through which the teeth have to pass. With some persons 
the pain is very acute, and frequently continues for several 
weeks, and sometimes for two or three years, as the tooth is 
making its entire appearance. Fluxions also supervene, fol- 
lowed by suppuration of the gums ; and the contraction of the 
muscles of the part is such, that it is painful for the patient to 
open his mouth. 

Some persons, during the eruption of the third molar, are 
affected with continued or irregular intermittent fever, with 
nervous symptoms about the breast or head. 

These fevers, after having resisted all remedies, generally 
disappear, and also most of the nervous symptoms, on the 
eruption of the teeth, which may be assisted by removing 
the portion of the gum that covers them. This operation, 
practised in time, immediately dispels the spasms, or the acute 
pains, the causes of which the patient did not suspect. To 
remove the portion of the gum that covers the decayed tooth 
we make use of the instrument, (as in Plate XIV. Fig, 4.) 

If the mouth has been contracted so that it cannot be opened 
sufficiently wide, we should apply leeches behind the ears, 
prescribe pediluviums and an application of cataplasms with 
flaxseed and a decoction of poppy heads. If it be possible for 
the patient to open his mouth a little, we should introduce in 
it St small quantity of barley-water, or a large fig. 

Under other circumstances, though the tooth has sufficiently 



56 



maury's dental art. 



appeared through the gum, we should not on that account hesi- 
tate to extract it, to remedy this evil, because its presence 
restrains the movements of the opposite jaw. If, however, it 
cannot be extracted, and there is urgent necessity for its 
removal, by taking away the anterior tooth we will alleviate 
the pain, and the remaining tooth will come into the place of 
the one that has been extracted. 



DENTAL PATHOLOGY. 



Having spoken of the different diseases which manifest 
themselves at the period of the eruption of the teeth, we shall 
now occupy ourselves with the examination of the diseases of 
the dental organs, proper; and, to proceed methodically in the 
classification of their various afiections, we will divide them, 
according to Professor Marjolin, into three principal sections. 
Thus, in the first, we shall speak especially of the anomalies 
that they present in their arrangement, and vices of form of the 
dental arches, having made known the difierent anomalies that 
they present in their number and situation. We will examine 
in the second section the diseases proper to their substance: 
and, in the third, the different affections of the parts adjacent 
to them. 

SECTION I. 

ARRANGEMENT OF THE TEETH. 

" The arrangement of the teeth," says M. Marjolin, " may 
present several kinds of irregularities. Some depend solely 
upon the mal-direction of the teeth, and others are the effect 
of an unnatural size of the dental arch." 

The first of these irregularities is called obliquity of the teeth, 
and may be anterior, posterior, lateral or rotary. The deci- 
duous teeth scarcely ever present a mal-arrangement, and 
among the permanentes the anterior teeth are more prone to it 
than the posterior. Several causes produce obliquity of the 
permanent teeth; such as, for example, a disproportion between 
their size and the space which they should occupy. (PI. XL 



58 



maury's dental art. 



Fig. 1;) the protracted molting of some of the deciduous teeth; 
the presence of any tooth, that diminishes the space which 
should be filled by the new tooth; the existence of a super- 
numerary tooth; and organic diseases of the alveolar ridge. 
This evil is often announced by the setting on edge or the loosen- 
ing of an adjoiningdeciduous orpermanent tooth, and theobliqui- 
ty of a tooth is often occasioned by the position of other teeth. 
The dental arch sometimes becomes deformed, and, under cer- 
tain circumstances, lesions of the tongue and cheek are the 
result. 

The following is the manner by which this vice of dental 
conformation may be remedied. 

When at the commencement of second dentition, there is ma- 
nifested, anterior or posterior to the inferior or superior cuspidati, 
a prominence indicating the presence of the permanent tooth, 
the deciduous cuspidati should be extracted, whether loose or 
not,* and others must be extracted as soon as those of replacement 
appear. If the extraction of two, three, or four temporary teeth 
should not afford sufficient room for the same number of per- 
manentes, we should not be too hasty in removing the next 
temporary tooth for fear of allowing too much space to the per- 
manent tooth, which would encroach upon the place that should 
be occupied by the next tooth of replacement. The dentist 
should attentively inspect the eruption of the second teeth, 
and not extract the deciduous unless he is assured that those of 
replacement will only have the necessary space for their good 
arrangement. When the inferior and superior incisores, and 
also the cuspidati, or the first bicuspides, are entirely through the 
gums, we should examine if the jaw be sufficiently developed to 
contain the teeth so as not to be crowded together. If it be not 
well developed, we should extract the first bicuspides,-]- and the 
teeth, then standing sufficiently apart, will not occasion the decay 
of each other, but will assume positions adapted to them. 

* It frequently occurs that the growth of the permanent incisores is more 
rapid than the destruction of the roots of the temporary teeth, and that the 
former emerge through the gums behind the latter. In such cases the tem- 
porary incisores should also be extracted. 

t The second bicuspides are the teeth proper to be sacrificed if the irregu- 
larity be slight, as the absence of these teeth cannot so easily be perceived. 



DENTAL PATHOLOGY. 



59 



But, in case of obliquity of divergencej we should be cautious in 
extracting the adjoining tooth, since this unseasonable extrac- 
tion would make the deviation greater and the separation of the 
teeth more extensive. 

The incisores and the cuspidati frequently assume an oblique 
position. There are dentists who pay so little regard to the 
symmetry of the mouth, that they do not hesitate to sacrifice 
a superior or inferior lateral incisor in order to allow sufficient 
place for the adjoining teeth to arrange themselves properly, 
either by the efforts of nature, or by the use of ligatures. It 
would be better to extract in the first instance the two first bi- 
cuspides, or only one, according to the exigency of the case, 
and then place a ligature of raw silk of the proper size around 
the cuspidatus and attach it to the first molar. The ligature 
should be renewed daily; and in about two or three weeks the 
cuspidatus will have occupied the place of the tooth that had 
been extracted.'^ 

* ^' The most frequent kind of irregularity, resulting from a narrowness 
of the jaws, is the projection of the cuspidati. These teeth, with the excep- 
tion of the second and third molares, are the last of those of the second den- 
ture that are cut, and are consequently more liable to be thrown out of the 
arch than any of the others, especially when it is so much contracted as to be 
almost entirely filled before they make their appearance. The common 
practice, in cases of this kind, is to remove the cuspidati. But as these teeth 
contribute more than any others, except the incisores, to the beauty of the 
mouth, and can, in almost every case, be brought to their proper places, the 
practice should certainly be discarded. 

"Therefore, instead of removing these teeth, room should be made for 
them by extracting the two bicuspides. Much judgment, hov/ever, is requi- 
site to determine which class of these teeth to remove. If betv/een the first 
bicuspides and the lateral incisores, there be spaces of one-half the width of the 
cuspidati, the second bicuspid should be extracted instead of the first; but 
if there be no such spaces, the first should be drawn; for although these might 
be carried far enough back, after the removal of the second, to admit the 
crowns of the cuspidati between them and the lateral incisores, yet still there 
would not be a perfect harmony of arrangement, for the fangs of these teeth 
would still cross each other; so that those of the bicuspides would be found 
deeply seated in the arch while those of the cuspidati would be thrown for- 
ward so much, that they would occasion considerable prominences in the 
gums that cover their alveoli; which, in consequence, would be gradually 
absorbed, and thus the teeth would be loosened and caused to drop out." 

In addition to the foregoing recommendation, which is extracted from Dr. 
C. A. Harris' '-Dental Art," we would advise the correction of the irregular 
growth of the incisores by means of the extraction of the bicuspides also, pos- 



60 



maury's dental art. 



We should be very careful in attaching the second bicuspid 
to the cuspidatus alone; this latter tooth having the stronger root, 
the former will be drawn toward it, and the object of the 
operator will be defeated. When the cuspidatus has been regu- 
lated we must bring the lateral incisor into its proper position by 
the same method. The space between the tooth now to be re- 
moved and that to which the ligature is to be attached for this 
purpose is wider by the distance of a tooth, and thus advantage 
will be had from the greater contractility of the ligature. The 
dentist who reasons on this will know the method by which 
teeth that overlap each other can be brought into their natural 
position. 

The last operation of the kind that came under our practice, 
was performed upon the young Canaris, the son of the intrepid 
Greek mariner of that name. This boy, aged nine years, had 
his right central incisor overlapping more than one-half of the 
left, and the lateral of the same side equally overlapped the cen- 
tral. We extracted the deciduous cuspidatus, and after placing a 
ligature around the second molar and lateral incisor, the latter 
was brought into the desired position, and we had only to place 
a similar ligature around the central incisor and the second 
molar, and in five days after, it no longer overlapped its neigh- 
bour. We continued ligatures for three months, being careful 
to renew them frequently, in order to retain the teeth in their 
proper positions. 

When a tooth protrudes from its socket beyond the level of 
the rest, we employ the ligature to restrain it, by passing it 
first around the tooth, then over its crown, and finally attaching 
it around the neighbouring teeth in such manner as to produce 
vertical pressure upon the affected tooth. (PI. XI. Fig. 7.*) 
The tension of the cord, thus continued, presses the tooth so 
as to force it into the place that we wish it to occupy; and 

terior or anterior, according to the exigency of the case. When this is done, 
however, the application of ligatures becomes necessary, to be applied first 
upon the cuspidati, and after upon the mal-directed tooth. 

* The object cannot be attained in the manner recommended by our author. 
No means can produce the effect desired that do not possess power at least 
equal to the pressure of antagonizing teeth against each other. We believe 
the best advised remedy to be the reducing of the length of the mal-directed 
tooth by means of filing, and its restoration to its place by means of force 
applied laterally. 



DENTAL PATHOLOGY. 



61 



this object being effected, we permit the ligature to remain 
upon it for a few months simply to keep the tooth in its new 
position. It often happens that these ligatures slide under the 
gums, which, becoming considerably inflamed, recede from the 
neck of the teeth and cause them to become loose. We remedy 
this inconvenience by the application of a hook upon those 
teeth which the ligatures are most liable to denude in this way. 

This species of hook has two curves: one is to be applied 
upon the crown or cutting edge of the tooth; the other reaches 
very near the neck of the tooth, and is fixed so as to prevent 
the ligature from slipping nearer than it is desired toward the 
gums. By means of this little fixture, the ligature then an- 
swers better than if its whole pressure was directed upon the 
root (PI. XI. Figs. 3 to 6.) We advise, whenever it is possi- 
ble, the placing of the ligature upon the molares, because these 
teeth are better capable of retaining it than the cuspidati which 
have the form of an inverted cone. 

We shall not now speak of partial luxation of the teeth, as a 
means of replacing them in a more suitable position: this pro- 
cedure is not always without danger. We will mention, how^- 
ever, that we have greater hopes of success from this operation 
when performed a short time after the eruption of the deviated 
teeth, and in a period little more advanced in life, that is to 
say, from eight to fourteen years. In fine, whenever the obliqui- 
ty of the teeth cannot be remedied, we should, as far as possible, 
correct the bad effects that may result from its presence. Hence, 
we may extract those that are too much deformed, or which 
injure the tongue, the cheeks or lips. We may even without 
inconvenience, excise .the crowns of some of these teeth, if 
they cannot be extracted.* 

The mal-directions that the dental arches may present are, 
prominence^ recession, and inversion. 

Prominence scarcely ever exists except where the jaws are 
too narrow to allow of a proper arrangement of the teeth. In 
such a case, the dental arches are very oblique, and projected 

* We would here state that luxation and excision are means that should 
never be resorted to. No enlightened practicien of the present day will 
tolerate such practices. We will have occasion in the second part of this 
work to speak more at large upon this subject.— S. 
6 



62 



mausy's dental art. 



anteriorly; they appear very long, and sometimes seem to fol- 
low the direction of the teeth. {Marjolin.) The central incisores 
are then projected so far forward and are so crowded together, 
that the mouth has more resemblance to that of a beast than to 
that of a human being. 

This mal-disposition of the teeth, of which examples are 
found among some nations, is sometimes hereditary; but its 
progress may be arrested by following the procedure which 
we have proposed ; that is, by being particular to extract the 
first right and left bicuspides, and by the application of ligatures 
so as to draw the cuspidati into the place previously occupied 
by the bicuspides. The four incisores afterwards yield of 
themselves, and the jaw gradually assumes a more agreeable 
form. The different metallic plates that are recommended 
for the correction of this evil, rarely produce favourable results; 
even metallic ligatures are not in such cases as valuable as the 
silken ones, which are more flexible and more easily adapted. 
We prefer raw silk or hemp ligatures; and when the teeth are 
brought to the place we wish them to occupy, we maintain 
them in that position, by means of a thread of aloes which is 
soaked for half an hour in hot water. This thread, one of the 
best ligatures that a dentist can use, distends itself, and in this 
manner we can employ it without fear of forcing the tooth to 
take a different direction from that which is desired. 

There are cases in which we cannot employ ligatures to bring 
the teeth into the places that they should have at first occupied; 
for example, an individual twenty or thirty years of age, who 
has one or more teeth situated behind the alveolar arch. The 
dentist, in the first place, should ascertain if the spaces between 
the teeth on the right and left of the mal-placed organ are suffi- 
cient to admit of these last being easily brought into proper 
position. Should it not be the case, he will file, as low down 
as the root, each one of them upon the lateral surface, and facing 
that tooth which he will afterward luxate from behind forward, 
to bring it into the circle of the neighbouring teeth.* 

* The period of life most congenial to the correction of irregularities of 
the teeth is the fourteenth year. The alveolus is at this age pliant, and, if 
it be impaired by the removal of the tooth, reparation is soon made by an 
osseoas deposite, and the tooth itself is more readily made to assume the 



DENTAL PATHOLOGY. 



63 



The key, or other instrument, in skilful hands, suffices to 
perform the operation and to effect a good result; but we also 
perceive that this luxation should be done slowly, and that the 
tooth should be released as soon as it is upon a level with the 
others. The tooth, being properly placed, very often remains 
in its new position without the assistance of ligatures. These 
should, however, be employed when they appear necessary. 

The dentist, who has sufficient command over his move- 
ments, will perform this operation with confidence, and will 
always succeed. A few weeks suffice for the alveolar border 
that has been forced from the tooth to approach it, and become 
as solid as it was previous to the operation. We have often 
had occasion to practise this operation in the several schools 
to which we are attached as dentist. 

Recession is," continues M. Marjolin, a vice of confor- 
mation opposite to the preceding. The anterior teeth are ob- 
liquely inward: it occasions deformity, difficulty of pronunci- 
ation, premature wearing away of the anterior parts of the 
teeth, and sometimes even ulceration of the inferior gums, 
rubbed by the contact of the superior teeth. This requires the 
filing, more or less, of the cutting edge of the teeth that cause 
the deformity. 

Inversion of the Dental Arches. — When the superior teeth 
shut within the circle of the inferior, and if even their tuber- 
cles are not regularly adapted, they are said to be inverted. 

desired position. If this operation be attempted at a period so late as is 
recommended by our author, the chances of success will be unfavourable. 

In relation to the use of the file in those cases Mr. Bell observes: " If the 
irregularity be very slight, and the want of space trifling, it will be sufficient 
to pass a very t^in file between several of the teeth, so as not to deprive any 
of them of the whole thickness of the enamel, and in this way considerable 
space will be gained by the approximation of all the teeth so treated^ and 
the irregular tooth be brought into its place by moderate pressure; but if the 
want of space be so great as to afford no hope of its being remedied by this 
mode, it often becomes necessary to sacrifice one of the permanent teeth." 

Professor C. A. Harris, in his lectures, repu4iates the use of the file in these 
cases, as the contact of the filed surfaces of the teeth, affording lodgment for 
extraneous matter, would hasten their decay. We cannot but regard this as 
a ^alid objection, and would at least advise much circumspection to be ex- 
ercised bj tkoss who would persist in the mode above reeommeBded.r— S. 



64 



MAURY's dental AST. 



The anterior parts of the superior teeth are thus often worn 
away, while in the natural state the contrary occurs. This 
want of regularity in the teeth, which we will call menton de 
vieillard, (old man's chin,) and not jimber-jaw, (PI. XI. Fig. 8, 
and PI. IV. Fig. 9,) may be remedied, particularly in chil- 
dren. Whenever the superior incisores and cuspidati alone 
shut behind the inferiors, we may bring them forward by 
means of an inclined plane, invented by M. Catalan in 1808. 
This instrument consists of a metallic plate attached to the 
inferior teeth, which projects some lines, and which is in- 
clined in such a manner as to push forward the corresponding 
superior teeth. We cannot but admire a process so ingenious. 
In able hands it possesses great advantages; and whenever it 
can be properly applied, from ten to twenty days are sufficient 
to establish the teeth in their proper places. We have observed, 
that, to put this in execution, we should wait at least until the 
four lateral incisores have entirely come through the gums, in 
order to offer a sufficient hold to the plate that is to be attached 
to them. 

Our method consists in appl^^ing a sufficiently large ligature 
to the two inferior central incisores in such manner that the 
tension of the ligature may force them back. When these two 
are replaced we are in like manner to replace the other two 
incisores; (PI. XI. Fig. 8,) but if we wish to regulate the cus- 
pidati, and the inferior alveolar border be more developed than 
the superior, it is necessary, previously, to extract the two 
first inferior bicuspides, first, to allow the preceding teeth the 
facility of taking the desired direction, and secondly, not to 
prevent the lateral incisores from taking their proper situation. 
There is no need of employing any thing to prevent the jaws 
from closing, as the pressure exercised by the ligatures is suffi- 
cient to prevent the inferior jaw from pressing against the 
superior. 

The dental arches, it will be perceived, themselves form a 
part of the irregularities of which we treat, as, also, do super- 
numerary teeth. These, as their name indicates, are not a por- 
tion of the regular complement: they are larger and differ very 
much in their form from the other teeth, which is always re- 
lative to the position they occupy in the mouth. We have 



DENTAL PATHOLOGY. 



65 



seen them in the superior jaw only. They are generally situ- 
ated between the two central incisores, (PI. IX. Fig. 9,) the 
cuspidati, the first or second bicuspides; sometimes above or 
at the sides of the molares, below the soft palate, and behind 
the central incisores, the lateral incisores, the cuspidati, or the 
first bicuspides. Those that are placed between the central 
incisores have their crowns rounded and pointed, and the root 
equally round. (PI. VIII. Fig. 16.) Generally, these teeth 
are not more than two-thirds of the size of the laterals. We 
have extracted some that were nearly as large as the cuspidati. 
(PI. VIII. Fig, 6.) The supernumerary teeth that are situ- 
ated between the cuspidati, and between or at the sides of the 
bicuspides, have the same form as these teeth, but they are 
smaller; and those that are sometimes found near the third 
molar bear greater disproportion to these. 

The supernumerary teeth, situated behind the central in- 
cisores, generally come in pairs; they are nearly as large as 
those teeth. The root has a peculiar curve, and the crown has 
the shape of a double crown, (PI. VIII, Figs. 6 and 11.) As 
to those that are placed behind the laterals or cuspidati, they 
are nearly as strong as these last, and present as a particular 
characteristic upon their root and upon their crown, three faces 
well developed, which terminate in a single point. 



SECTION II. 

DISEASES OF THE DENTAL SUBSTANCE. 

Among the various diseases that affect the dental organs, 
some attack the hard structure, others involve the soft. Thus, 
we find in the first series, denudation, fracture, atrophy, decom- 
position of the enamel, discoloration, caries of the teeth, destruction 
of the roots, and even their exostosis. The second series pre- 
sents inflammation of the dental pulp, its fungosity, its ossifica- 
tion, and the difierent dental neuroses. The third includes the 
diseases of the teeth relative to their connexions, loosening, 
luxation, denudation of the roots, concretions which are formed 

6* 



66 



maury's dental art. 



upon the teeth, &c. We will also arrange in this series odon- 
talgia, or tooth-ache. 

As we have already well established our principal divisions, 
we shall now give in detail the particulars of each disease. 

Denudation of the Teeth. — Although the teeth, in their 
natural structure, are much stronger and more compact than 
any of the other bones of the human body, they present a 
number of circumstances during life which contribute to pro- 
duce denudation; such, for example, as their bad organization; 
chemical influence from certain aliments; their friction during 
mastication (PI. XIII. Figs. 3, 4;) the use of dentifrices that 
are not sufficiently pulverized, those composed of acids, stiff 
brushes (PI. XIII. Fig. 5;) the use of pipes made of clay 
(PI. XIII. Fig. 6;) the habit of chewing on one side; the ac- 
tion of cracking substances with the teeth capable of breaking 
the enamel (PI. XIII. Fig. 2;) gnashing the teeth during con- 
vulsive affections of the muscles of the jaws, &c. There are 
some persons who, during sleep, experience habitual convul- 
sive movements, which occasion friction of the teeth, and pro- 
duce very soon a wearing down of their substances.* 

This organic lesion, in which the dental substance is more 
or less destroyed, takes place in the teeth of most animals; it 
is attendant upon age, and manifests itself in all individuals. 
" It is," says M. Duval, partial or total, vertical or horizontal; 
it occasions a change of volume and form of the teeth, which 

' Of denudation of the teeth, J. Hunter observes: " From its attacking 
certain teeth rather than others, in the same head, and a particular part of 
the tooth, I suspect it to be an original disease of the tooth itself, and not 
to depend on accident, way of life, constitution, or any particular manage- 
ment of the tooth." 

"That Mr. Hunter has mistaken the cause of this denuding process," 
says Dr. E. Parmly, " is evident from the following fact, which seems to in- 
dicate that this disease results from the condition of the fluids of the mouth. 
I have seen many examples in which artificial human teeth have suffered 
this denuding process exactly in the same manner as the original teeth in 
the same mouth. But the following instance seems to settle the question be- 
yond all doubt. A gentleman who had lost his teeth, partly from this cause, 
came to us about four years ago from a considerable distance, to procure ar- 
tificial substitutes. A set of human teeth of the best quality were accordingly 
provided, which, in the course of three years and a half, on his return to us, 
were found to be grooved from the surface to the central cavity," — S 



DENTAL PATHOLOGY. 



67 



are not then easily recognised." We will add, that several 
particular circumstances may diversify this mode of denuda- 
tion ; and it has been noticed that the incisores are worn away 
much more promptly in the absence of the molares; but these 
last are frequently thus afiected. The part of the tooth that 
has been denuded is never reproduced ; but in proportion as 
the crowns wear away, there appears to be a process of ossifi- 
cation going on in the dental cavity, which does not always 
prevent these teeth from becoming sensitive by the contact 
of cold, heat, or acids. The denuded part is never the subject 
of disease unless it contains a cavity. 

By an examination of the interior of denuded teeth, M. 
Rousseau, whom we have several times quoted in the course 
of this work, discovered not only the same variety of colours 
as in the grinding surface, but, moreover, a new ossified sub- 
stance, that formed and increased at the part worn away, and 
which he called osselet (small bone.) (PI. X. Fig. 4.) This 
substance, yellower than the other parts of the teeth, is, like 
them, transparent and brittle; it does not form a regular struc- 
ture, detaches itself from the dental cavity, by separating all 
at once from it; and the sides that correspond to this cavity are 
much more sensitive than its internal surface. 

In endeavouring to remedy the inconveniences that result 
from denudation of the teeth, we are governed by the cause 
that produces the affection. If, for example, a tooth become 
denuded by friction with its antagonist in the opposite jaw; 
or if it press upon such as may be diseased, or even if the 
different forms of the tooth occasioned by denudation produce 
deformities that injure the adjacent soft parts, we should cut it 
away with the file. Supposing that badly prepared dentifrices 
have occasioned the evil, we should suspend their use. When 
the tooth is very much denuded, or has become very painful, 
we must expose, w^ith a drill, the cavity resulting from that 
alteration; and afterward destroy the nerve with a hot iron,* 

* It will be perceived that the actual cautery is a favourite remedy with our 
author. It has indeed been popular, and good effects have often resulted 
from its use; but still, as it is productive of much pain, as the inflammation 
resulting from its use in the destruction of the dental nerve is often serious, 
and, especially, as recent investigations have supplied an agent at once more 



t 



68 



maury's dental art. 



and plug the cavity. If this operation is impracticable, we 
should cauterize the crown of the painful tooth, which will for 
a long time render it insensible. Persons who gnash their 
teeth should place a piece of linen or any other kind of soft 
substance between the jaws, to prevent the teeth from rubbing 
upon each other. 

Cracking of the Teeth. — This is, properly speaking, a small 
superficial fracture, (PI. XIII. Fig. 2,) and does not produce 

potent and safe for effecting this object, we are prepared in unqualified terms 
to condemn the mode above recommended. The importance of this subject 
will justify us in laying somewhat ample contributions upon accredited au- 
thorities for the purposes of elucidation. 

Professor C. A. Harris says: " The use of cautery may often be successful, 
but inasmuch as it almost always produces inflammation in the investing and 
alveolar membranes, I cannot unreservedly recommend it.'' Dental Art, p. 171. 

Dr. W. E. Ide, of Ohio, in a communication to the American Journal of 
Dental Science (March, 1842) remarks: " A safe and efficient agent for de- 
stroying the nerves of teeth has ever been a desideratum. Among the various 
things that have at different times been suggested for this purpose, none has 
been more unqualifiedly lauded by some and condemned by others, than 
ARSENIC. In the ' Guide to Sound Teeth,' published by Dr. Spooner of New 
York, in 1836, public attention was first called to its use, and its qualities are 
extolled in no measured terms. In a work soon after published by Dr. Bur- 
dell, its use is condemned as cruel, ineffectual, and dangerous. In volume I. 
p. 227, Journal of Dental Science, Dr. S. Brown says: ' Of all the remedies 
which have hitherto been generally made known to the profession in this 
country, arsenic is unquestionably the most prompt, safe, and effectual, when 
properly applied.' The opinions of such men as these, surely no one ac- 
quainted with his profession will treat with disrespect: but, as these doctors 
disagree, it may be difficult for the inexperienced to decide. As the matter 
now stands we fear that some may wholly discard a valuable remedy, while 
others may use it so indiscriminately as frequently to fail of the beneficial 
results that might otherwise be obtained. In the hands of the above men- 
tioned gentlemen who have recommended it, it has doubtless been so judi- 
ciously used as to be unattended by the objections that have elicited this com- 
munication: but others, as we have done, may use it in a manner to make a 
caution not altogether unnecessary. 

" We have used it pretty freely for more than three years, and though we 
find it a remedy of much value, and one for which we have been unable to 
find a substitute, its use has sometimes been attended by effects that should 
be known to the inexperienced. One objection that has been urged against 
it is, that the use of a poison so virulent as arsenic, cannot be unattended by 
danger. If properly used, I conceive this objection can never be valid, as 
the quantity necessary to produce the most desirable result can never be pro- 
ductive of any serious consequences. The power of the remedy should only 



DENTAL PATHOLOGY. 



69 



any morbid alteration of the tooth. It is produced by very 
many causes. It may, indeed, be often occasioned by gnashing 
the teeth, by accident, by biting hard bodies during masti- 
cation, and is often caused by endeavouring to crack solid sub- 
stances with the incisores, and sometimes by the use of the 
file. The pain, at the time of the accident, is more or less 
acute according to the extent of the injury, and the tooth is 
for some time after susceptible of the impressions of heat, cold, 
acids, or the friction of hard bodies upon it. Such injured 

be a caution to the inexperienced against the use of a quantity that may be 
as unnecessary as dangerous. A second objection has been founded on the 
pain which is said to result from its applica ion to an exposed nerve. 

"In our first experiments we used. simply three parts of arsenic and one of 
acetate or sulphate of morphine, and, contrary to our expectations, in nearly 
all cases where the nerve was much exposed, the application was attended by 
a considerable amount of pain. When the nervous pulp of a molar tooth 
was denuded and inflamed, the pain was often excruciating. More recently 
we have used equal parts of arsenic and morphine, A small quantity of this, 
say one-fifteenth or twentieth of a grain, is sprinkled on a piece of cotton 
that has previously been saturated with kreosote, and carefully applied to 
the exposed nerve, after as much of the foreign matter as practicable has been 
cautiously removed from its surface. Over this, white wax is to be applied 
in a manner to prevent pressure, and the whole permitted to remain five or 
six hours. If the preparation is applied to more than one tooth at the same 
time, the patient should be cautioned against swallowing his saliva, lest nau- 
sea to a greater or less extent be the consequence. Since having used the 
kreosote, we have found the amount of pain to be very materially diminished, 
but never entirely wanting, if the nervous pulp is much exposed. Where 
the bony parietes of a tooth is sensitive to such a degree as to make its prepa- 
ration for a plug painful, this sensibility can always be perfectly removed, and 
with no pain, by this application. But this practice is not unfrequently fol- 
lowed by results which constitute the chief objection that we desire to point 
out in this communication. As is recommended by many at the present time, 
it was our former practice to apply it in all cases where the nervous sensi- 
bility of a carious tooth was such as to make its preparation for a plug painful. 
In teeth that are highly organized, especially in young persons, every dentist 
knows that a carious surface may be exquisitely sensitive though the nervous 
pulp may not be exposed. This is especially the case with the incisores and 
cuspidati. In such cases, as we have before said, the application of arsenic 
will entirely remove the morbid sensibility for the time, and the tooth can be 
plugged with the greatest facility. But it often occurs that, in a few days, 
the whole tooth becomes so exquisitely sensitive, as to be affected by the 
slightest change of temperature. If the enamel is thin and transparent, the 
tooth assumes a purple or reddish brown colour, and the investing membrane 
of the fang becomes more or less inflamed, as is indicated by pain in occlusion 
of the jaws. Where the absorption of the poison is slight, this appearance 



70 



maxjry's dental art. 



parts are generally filed in order to prevent their angles from 
injuring the soft parts of the mouth that may come in contact 
with them, and to give the tooth a more agreeable form. 

Fractures of the Teeth. — Fractures of the teeth differ from 
the foregoing, inasmuch as the lesion of the former is more 
extensive than that of the latter. It may occur at the crown, 
root, or neck of the tooth ; and its direction may be transverse 
or oblique. (PI. XIII. Fig. 7.) These fractures, as is seen, 

subsides in a few days, and the tooth is restored to its original colour. In 
other cases, where the morbid effect was more marked, the inflammatory symp- 
toms have continued from one to two months, when the tooth would become 
perfectly destitute of vitality. The purple colour would then be changed to 
a dark brown, that permanently destroys the beauty of the tooth. la one or 
two instances I have removed plugs that have been in such a tooth for two 
years or more, and not the slightest trace of vitality has been discovered. The 
nerve and blood vessels through the whole dental canal have been completely 
destroyed, though they could have been in contact with the preparation only 
through the medium of absorption. If the enamel of a front tooth is par • 
tially transparent, and the patient young, indicating activity of the absor ■ 
bents, he should bear the pain of having it prepared for a plug without the 
use of arsenic, rather than endanger its beauty. If the tooth be opaque there 
is little danger of absorption taking place; but in this case the bony parietes 
are rarely so sensitive as to render any application necessary. If in the above 
cases we do not entirely discard the use of arsenic, it would probably be 
better to continue its application to a particular tooth not more than one hour, 
and then proceed immediately to cleanse and plug. By this practice absorp- 
tion may be, to some extent at least, prevented, and the desirable results par- 
tially, if not wholly obtained. 

"If the nervous pulp of an incisor or cuspidatus is exposed, especially in 
a young person, it is better to destroy it by thrusting a small instrument up 
the dental canal, as by this means the portion of vitality which is derived 
from the external periosteum will, for a time at least, be retained." 

In commenting on the foregoing, Dr. C. A. Harris remarks: "The effect 
which it (arsenic) has, when applied to the teeth of very young persons, as 
described by Dr. Ide, we have frequently noticed, and for the last two year? 
have refrained from applying it to the teeth of very young subjects, unless 
urged to it by the most pressing necessity." 

The following succinct description of the mode of applying arsenic is from 
the pen of Dr. J. J. Greenwood of New York: 

^* When a patient applies to me for the cure of toothache, I examine the 
tooth, and clean out the cavity, endeavouring to make bare the nerve, if 
practicable, with a small instrument. If the nerve bleeds, so much the better. 
I then wipe out the cavity with raw cotton, steeped in the essence of pepper- 
mint, laudanum, or alcohol. After which, I take raw cotton of sufficient size 
to stop up three-fourths of the cavity of the tooth. 1 dip the point into lauda- 



DENTAL PATHOLOGY. 



71 



affect different parts of the dental organs. Sometimes, indeed, 
only a portion, at other times the whole crown is affected. 
Under other circumstances, on the contrary, the fracture runs 
from the root to the neck of the tooth, which may be split 
from above downwards, or only fractured in that direction. 

A violent blow, a fall upon the face, making a fulcrum of 
the tooth without necessary precaution in the extraction of a 
neighbouring one, rachitis, scorbutus, syphilis, or any other 
morbid affections susceptible of rendering the teeth brittle, are 
so many causes that may render the teeth liable to fracture. 
A tooth may often appear to an inexperienced eye to be sound, 
though it be more or less decayed in the interior of its crown, 
and although it may not occasion the least pain, the dental 
substance being protected, its weakest part may still be frac- 
tured by motions in mastication. 

num, so as somewhat to saturate the cotton with it, that the mixture 1 shall 
mention may adhere to it. I then take upon the point of it, by touching 
the mixture, about the size of a large pin's head, and in no instance do 1 ever 
use more, however large the cavity in the tooth, but sometimes a smaller 
quantity. This I place in the cavity of the tooth, immediately in contact, 
if I can, with the nerve, and stop up the cavity with mastic, composed of 
Venice turpentine, heated, and mixed with calcined plaster of Paris and 
chalk. Feuchtwanger's Prussian cement for the teeth will answer, placed 
upon the raw cotton in the tooth, and sometimes mixed up with it so as to 
fill up the cavity, charging the patient to take it out in three days exactly, 
and in no wise to masticate on that side during the time. If patients will 
come to me, which they generally will do, I take it out for them, which I 
prefer to do, and wash out the cavity with alcohol. The tooth is by this time 
cured; but for fear there may remain an ichorous fluid oozing still from the 
dental canal, I leave it for three days longer, when the organ is fully pre- 
pared and ready for stopping. The symptoms of the efficacy of the cure 
are these, namelj'; the pain, after commencing, will endure for three or four 
hours, sometimes more, according to the irritability of the patient. After 
tlie acute pains have passed away, a soreness will continue for some time, 
accompanied by a looseness of the organ, occasioned by the inflamed state 
of the periosteum. This gradually dies away, and by the second or third 
day, in almost every case, disappears. If, when the raw cotton and the mastic 
are removed on the third day, the patient takes cold water in the mouth, and 
no pain arises from it, the cause is removed. This is the proof in all cases. 
I have been thus prolix in order that you may be supported by one who has 
tested its efficacy for years with success, and, indeed, I make use of no 
other remedy. 

Mixture, to be placed in an ounce glass vial, with glass stopper. 
9<, Three parts arsenic 

One do. acetate morphine, Misce. — S. 



72 



matjry's dental art. 



The impression of heat and cold, the action of acids, the 
rubbing of hard bodies, cause more acute pains upon fractured 
teeth than upon those that have only been cracked. This sen- 
sitiveness may last for several months, and even for years, ac- 
cording as the fracture is more or less extensive. It may even 
last until ossification has gone on in the internal side of the 
cavity of the tooth. Teeth thus affected often become yellow 
or blackish, and only decay when the fracture occasions a 
cavity, which is very rare. They are also as hard as the others. 
I have a lateral incisor that has been fractured in the middle 
of its crown for twenty-five years, and which has not for 
twenty years occasioned the slightest pain. It is as sound as 
my other teeth. 

The means that are employed to obviate inconveniences 
which may result from a fracture of a tooth are generally 
simple, and their choice, in most cases, is left to the intelligence 
of the dentist: but, previously to adopting any measures, he 
should well examine that portion of the tooth that has been 
injured. 

When the fracture has not reached the dental pulps, we 
cauterize the newly exposed part, that it may be less suscepti- 
ble to the impressions of the atmosphere. If the pulp be 
nearly exposed, we must lay it entirely bare with a drill; we 
cauterize it, and also the nerve, and plug the cavity of the 
tooth. (PI. XIII. Fig. 7.) When the fracture extends near to 
the neck, after having destroyed the sensibility of the tooth, 
we should prepare the root for the reception of an artificial 
crown, if it be in the anterior part of the mouth, or in other 
cases we should plug the root.* 

If the fracture be lengthwise, and if it extend to the root of 
the tooth, we should immediately extract the loosened frac- 

* The roots of the molares should never be permitted to remain in the 
mouth, as they will be a continual source of irritation to the gums, sockets 
and maxillary bones; and this irritation being often communicated to the 
nervous system, produces a general derangement of the whole economy. 
These objections do not so much apply to the roots of the incisores and cus- 
pidati ; as these are known to remain for years without exercising any inju- 
rious influences, and they are, moreover, useful for the reception of artificial 
crowns. The remarks we have already made on the actual cautery wiU 
apply to the above. — S. 



DENTAL PATHOLOGY. 



73 



tured parts: their retention in the alveolus may produce vio- 
lent pains, inflammations, abscesses, and many other evils. A 
similar operation is indicated in subjects of from ten to fifteen 
years of age, whose neighbouring teeth may approximate and 
close the aperture resulting from the loss of a fractured tooth. 
We cannot, therefore, be too careful in extracting, or in endea- 
vouring to obtain a consolidation of fractured teeth, since, if 
they are left to themselves, an inflammation of the dental 
pulp, and of the alveolus, a cyst at the extremities of the 
roots, (PI, IV, Fig. 3,) a fistulous abscess, a discharge of fetid 
pus, and finally caries, will nearly always result. 

Erosion of the Teeth. — Erosion or atrophy of the teeth is a 
disease peculiar to their enamel, and which, in its development, 
presents three varieties, each of which we shall carefully 
examine. 

The first -variety of dental erosion consists in spots of a 
milky whiteness, or of a deep or light yellow, irregular, and 
situated in the enamel of the tooth, the polish of which it does 
not affect. These spots remain stationary, and nothing can 
efface them. The second variety is the most common of all. 
Like the first, it only affects the enamel, and it presents little 
crowded holes, resembling quilting, irregular depressions, 
whose surfaces are not always polished, or even transverse 
sinuosities, single or divided by prominent lines; (PI. XII. 
Fig. 12;) the sinuosities are sometimes yellow, but often of 
the same colour as the enamel. As to the third variety of 
erosion, it differs very much from the preceding, for it affects 
the whole dental substance, particularly the bone of the tooth, 
which is only imperfectly developed. (PI. XII. Figs. 7 and S.) 
The tooth itself does not possess its whole dimensions; it is 
often entirely or nearly deprived of one of its parts. Some- 
times its crown is reduced to one-third of its natural size;" 
sometimes it is divided by a deep circular depression ; at other 
times the grinding surface of a molar presents a kind of cavity. 
Under some circumstances it offers asperities, whose summits 
are covered with enamel, of which their base is totally de- 
prived. It has been observed that the roots of eroded teeth 
7 



74 



maury's dental art. 



have sinuosities and prominent circular lines, are knotty and 
very short. 

These various species of erosion that attack the enamel of 
teeth, produce sometimes such deep holes as to communicate 
with the dental pulp: they often constitute a local disease of 
the parts in connexion with the teeth, but oftener a general 
affection, at the period of the formation of their enamel. It 
appears that, at this time, nature, not possessing sufficient 
vigour, is arrested in her operation. But, at the same time, the 
osseous portion of the tooth is growing, and the enamel only 
covers it as the health is re-established if it again decline, the 
enamel is again arrested in its formation. We witness teeth 
that have three and four lines of erosion, (PI. XII. Fig. 12,) 
and we may say that the child has been sick as often as there 
are lines upon his teeth. This malady may also be occasioned 
by scrofulous or scorbutic affections, or by a disease contracted 
by the foetus in the womb of its mother, or communicated 
during lactation. This atrophy is congenital, and is not pro- 
duced by a consecutive alteration of the crown of the tooth 
after its formation. 

Although it is difficult to erase those kinds of alterations 
resulting from dental atrophy, we should endeavour to combat 
their causes, either by preventing them, or by arresting their 
progress. This disease, however, requires no local treatment ; 
and the only advice that can be given, is to endeavour, by ap- 
propriate treatment, to eradicate the general affection that has 
produced it; this appertains more properly to the medical 
practice than to that of the Surgeon Dentist. 

Decomposition of the Enamel—This affection presents, like 
atrophy of the teeth, three varieties. The first is the most 
frequent, and manifests itself by some brown or blackish spots 
which are developed upon the anterior face and the sides of 
the crown. These spots may extend as far as the internal 
face of the enamel, which, in most cases, preserves its polish, 
or becomes rough by a slight wasting of substance. They are 
produced, either by a disease of the dental pulp, or by great 
pressure of the teeth incased in alveolar borders too narrow to 
contain them, or, lastly, hy the contact of decayed teeth. 



DENTAL PATHOLOGY. 



75 



This alteration of the enamel does not render the teeth 
painful, and is spontaneously arrested as soon as that which is 
affected ceases to be in contact with the diseased parts. 

The second species of decomposition of enamel is easily 
known by the loss of its polish, the facility with which some 
particles of the part may be taken away, and by the extraordi- 
nary whiteness that the substance at first acquires, and which 
is afterward lost. This decomposition generally manifests it- 
self near the anterior border of the gums, but may extend to 
the osseous substance : the teeth at first are very sensible to 
the impressions of heat and cold, and even to the conflict of 
solid bodies ; they become yellow where the enamel is lost, 
and incrustations of tartar, or viscid secretions, more easily 
adhere to them. This disease is the commencement of a decay 
very hard to destroy; it shows itself particylarly upon the 
external neck of the inferior molares, after long sickness, or in 
persons of a bilious temperament, whose teeth are continually 
bathed in viscous saliva. When this affection is slight, it dis- 
appears upon the re-establishment of health, and its progress is 
also diminished, by daily cleansing the teeth, particularly the 
diseased part, with a soft brush. 

The third variety, which is difficult to recognise at the 
moment it shows itself, presents a superficial wasting of the 
enamel, at the anterior part of the crown, under the form of 
an oval or circular facet, which gradually increases in size or 
depth. This facet is at first as white as the enamel ; it after- 
ward assumes a yellow hue, and the denudation of the osseous 
part of the tooth that results from the disease, renders it sen- 
sible to the slightest touch : generally atrophy of the teeth 
alters the enamel, and sometimes disorganizes it. Independent 
of this it does not influence the diseases of the dental substance 
proper. The treatment of this third variety, consists in cutting 
away with a file the defective portion, or in plugging the 
cavity, should any exist. 

Discoloration of the Teeth — The teeth of first dentition are of 
a milky whiteness and very brilliant; but the hue of those of 
adults corresponds to the good or bad constitution of the sub- 



76 



maury's dental art. 



ject;* they do not always present the same colour nor the same 
polish^ and are, in certain individuals, of a bluish or opaque 
white. Young persons, who, from the period of ossification 
of second dentition, until the eruption of these teeth, are afifect- 
ed in their lungs, have generallj long and thin teeth of a 
milky white enamel and transparent. Those, on the contrary, 
whose enamel is of an opaque or grayish white, and are shorter 
than the preceding, are indicative of a better constitution. 
When ossification is completed, and the enamel is of a wliitish 
yellow, and the teeth short, particularly if the person be cor- 
pulent, good health is usually indicated. 

During life the teeth may undergo alterations in colour, in 
the course of different affections to which man is subjected; 
but they soon resume their primitive colour when the disease 
has been of but short duration. If, however, the disease be 
manifested after the thirty-first year of age, it is probable that 
the teeth will preserve the hue that they assumed during its 
continuance. We shall not consider as discolorations of the 
teeth, those large blackish spots, and more particular!}^ green- 
ish ones, which are sometimes found near their necks. These 
spots are superficial, although a rugine cannot detach them 
like tartar: we can, however, destroy them by means of a 
piece of porous wood dipped in fine moistened pumice stone. 

Teeth usually have a somewhat yellow hue. In order to 
whiten them, acids, cream of tartar, tobacco leaves, snuff, 
quinine, &c., have for some time been made use of.t 

* The colour and density of the deciduous teeth are as much influenced 
by the state of the health of the mother and infant during the ossification of 
their crowns, as are those of the permanent ones, by the operations of the 
economy at a later period of life, at which they are undergoing solidification. — S. 

t Of the injurious influences of acids upon the teeth, Mr. J. Snell re- 
marks ; ''By the improper use of acids, that beautiful polish natural to the 
enamel is injured ; and where the application is repeated, layer after layer is 
removed, or honey-combed pits and spots of brown appear, and the teeth 
become morbidly sensible to changes of temperature, pain being produced 
from cold air or water.'' 

"The application of strong mineral acids," says T. Bell, "for the purpose 
of assisting in the removal of tartar, is to be deprecated as excessively inju- 
rious, as it dissolves the enamel and the earthy part of the bone wherever it 
comes in contact with them. The immediate efl^ect of the treatment is to 
render the teeth beautifully white, but, in a short time, the surface of the 
enamel being made rough, and, as it were, eroded, they become again dis- 



DENTAL PATHOLOGY. 



77 



Caries of the Teeth. — The name caries has been given to the 
gradual desti^uction of a part or the whole of the dental sub- 
stance. 

This affection often commences upon the la3'er of enamel, 
which is thinnest nearest the bone of the tooth, (PI. XII. Fig. 
15;) it often shows itself in little black spots upon the lateral 
surface where the teeth are in contact with each other, or upon 
the little inequalities in the crown of the enamel, (PI. XII. Fig. 
14,) which very soon loses its transparency and colour. In 
this way the disease becomes visible. Its progress is sometimes 
so rapid that it occasions the destruction of the bone before its 
morbid influence has decomposed the enamel. As the disease 
of the bone deprives the enamel of its support, the slightest 
pressure in mastication breaks it, and then a cavity is found in 
the tooth, the size and depth of which imperceptibly increases 
until the disease penetrates the interior cavity. (PI. XII. Figs. 
10 and 19.) The membrane that lines the tooth, being then 
exposed to the action of the atmosphere, and aliment, and all 
external agents, becomes inflamed and irritable to such a degree 
as to produce pain, the intensity of which is always in propor- 
tion to the rapidity of the progress of the disease, to the thick 
ness of the osseous substance of the tooth, and to the narrowness 
of the cavity. Pain is not always a proof of the progress of 
caries, for we observe teeth that have been completely de- 
stroyed without having given rise to the slightest inconve- 
nience. Decay of itself is not painful : the diseases of the 
I nerve alone produce the sensibility of the dental organ. It 
also is seen that one part, which is the seat of the disease, 
ceases, for a longer or shorter time, to be painful, and after^ 

coloured, and, if the application be frequently repeated, the bone is exposed, 
and gangrene is the inevitable consequence." 

Knowing as we do that the same elements enter into the composition of 
dental tartar that compose the teeth themselves, and that hence the latter are 
just as susceptible to the action of any chemical agent as the former, it 
seenjs indeed astonishing that any intelligent person could be indiscreet 
enough to use such. 

Whether tobacco be injurious to the dental organs or not is a controverted 
point. Be this as it may, however, its deleterious effects upon the gums, and 
upon the system generally, should induce us to condemn the use of it, with- 
out reference to the disgust that should be felt for so filthy a practice. — S, 

7^ 



N 



78 



maury's dental art. 



ward becomes insensible for a long time, or even for ever 
after. This we have noticed, and presume it has not escaped 
the generality of dental observers. 

No disease is more frequent or more serious than caries of 
the teeth, since, independently of the pain that it usually occa- 
sions, it tends to the destruction of the affected tooth. This is 
not uniformly the case, for we have seen caries spontaneously 
arrested, or remain stationary for a time, and even for ever. 

Decay manifests itself upon the exterior of the teeth. The 
molares are more subject to it than the incisores or cuspidati: 
it generally attacks these upon their lateral surfaces, and 
scarcely ever upon their cutting edges or lingual faces. In the 
molares the little cavities on their grinding surfaces are gene- 
rally the primitive seats of this disease. Incisores and cuspi- 
dati that are irregular are particularly subject to decay. It is 
rare for decay to affect the roots of the teeth; it is nearly 
always arrested when it reaches that portion of the dental 
organ. It is still more uncommon for it to penetrate to the 
extremity of the root; this part in most cases remains in all its 
integrity, while the rest of the organ has been entirely de- 
stroyed. The wisdom teeth, says M. Marjolin, when their 
eruption is prolonged, are sometimes decayed while they are 
coming through the gum; and it often happens that several 
corresponding teeth, of the same side, in the same jaw, are af- 
fected with caries at the same time, or at very short intervals, 
which can be explained rather by the density of their structure 
than by the distribution of the nerves that they receive. 

The deciduous teeth, like those of replacement, are often af- 
fected with decay, either in consequence of sickness, or by a 
natural tendency. Generally, the incisores are the least ex- 
posed to this disease, and when they manifest it, it is generally 
in those of the upper jaw, the crowns of which are gradually 
destroyed as far as the gum without occasioning severe pain. 
The inferior molares are of all others the most subject to it, 
the disease makes rapid progress in these, and produces such 
suffering that extraction becomes necessary. They, however, 
are often retained without ever being attacked by disease. 

As we have already said, decay commences sometimes in 



DENTAL PATHOLOGY. 



79 



the neighbourhood of the dental cavity.* It is developed upon 
the crown, under the enamel, and in the root, upon its surface. 
It never affects the sides of teeth started from their sockets, or 
a portion of a root for a long time denuded. It occurs in 
children, youths^ and in mature age: but the teeth of old men, 
and even of men of fifty years of age, who are endowed with 
good constitutions, seldom decay. Those of women are more 
subject to it than those of men. 

Decay of the teeth is so common that few persons, even 
among youths of good health, are altogether exempted 
from it. We have for this purpose collected facts that appear 
to us to leave no doubt upon this point. Situated as we were, 
as dentist in several boarding-schools, we examined the mouths 
of more than a thousand pupils, and can affirm that, of this 
number of persons, of whom more than five hundred were six- 
teen or twenty years of age, we met annually from five hun- 
dred and fifty to six hundred decayed teeth. Five hundred 
and fifty appears to be about the average number according to 
the examinations made every five or six months. 

Authors have never agreed upon the true cause of decay. 
Hunter supposed it to be a hereditary disease, and regarded it 
as a kind of necrosis or mortification of the dental substance; 
and Fox thought that it was a defect in the primitive formation 
of the teeth. Some have thought that dental caries should be 
classed among ulcerous affections, while others are modest 
enough to say that they know of no reason why the teeth 
should decay. For us, we believe that the disease is produced 
by primary causes, and that the causes are both external and 
internal. 

The external Causes of Decay are blows and contusions ; all 
lesions of the teeth; the contact of cold air determining flux- 
ions; the application of substances capable of altering the 
dental organ or increasing its nervous sensibility; the frequent 
use of acid drinks or aliment; the habit of taking at the same 
repast very cold and hot drinks; the constant presence of saliva 
upon a certain part of the enamel of the tooth; and, we may 
add, malformation; lateral pressure of the teeth against each 

* See in a subsequent page our remarks upon internal decaj. — S. 



80 



maury's dental art. 



other; affections of the gums; malaria; the use of certain me- 
dicines, as mercury, acids, &c.; uncleanness; and such irregu- 
larities as permit viscous substances to penetrate their spongy 
parts, &e. 

Among the internal Causes of Caries,\ve enumerate the weak 
and soft texture of teeth indicated by a milky whiteness, or 
bluish cast; congenital erosion; and organic or accidental dis- 
eases, such as scrofulous, syphilitic, gouty, rheumatic, variolous, 
scorbutic, acute or chronic inflammatory, gastric, nervous, ady- 
namic affections, &c.; and precocious growth of the permanent 
teeth at the period of their formation.* 

* "If it were true that inflammation was necessary to the disease, it would 
never occur except in livincr teeth, and it is notorious that dead teeth are as 
liable to its attacks as living ones. It exhibits, too, in these., all the pheno- 
mena that are manifested by it in the others. This is true, not only with 
regard to teeth that have lost their vascular connexion with the general sys- 
tem, and are still retained in the mouth, but also with those that are placed 
there by art, if fabricated from bone or ivory. The vitality of the teeth may 
influence the progress and character of the decay, though I am not certain 
that it does, but it is not, by any means, essential to it. 

" If the decay of the teeth then is not referable to inflammation in their 
bony structure, to what is it to be ascribed ? The inference is, that it is the 
result of the action of chemical agents, and when we take into consideration 
that the fluids of the mouth, when in a morbid condition, are capable of de- 
composing their enamels, if not possessed of more than ordinary density, and 
that the disease frequently commences upon this outer covering, the conclu- | 
sion is at once irresistible. A most remarkable case of this description of 
caries (called by Mr. Hunter decay by denudation,'') is mentioned by Dr. | 
Eleazar Parmly, in his notes to this gentleman's treatise on the teeth, pub- | 
lished in the American Journal of Dental Science, in which the labial sur- * 
faces of several natural teeth, that had been artificially placed in the mouth, ! 
were attacked by it. \ 

" It may, however, be asked, if caries of the teeth be produced by the action II 
of external agents, how is it that the disease sometimes commences within 
the bony structure of the organs, and makes considerable progress there, be- \ 
fore any indications of its existence are observable externally? I answer, 
that it never does commence within the bony structure of the organs; its 
attacks are always upon their external surfaces, sometimes upon the enamel, 
but most frequently upon the bone within the indentations on the grinding 
faces of the bicuspides and molares, and on the sides of the teeth at the points 
where they come i<i contact with each other, and where this outer covering 
is frequently so fractured by the pressure that is exerted upon it, that the 
juices of the mouth find ready access to the subjacent osseous tissue. The 
destruction of the organs may be gradually going on here for months and 
even years without any notable signs of its existence; the coramencement 



DENTAL PATHOLOGr. 



81 



Without instituting a special examination into the character- 
istics of dental decay, arbitrary classifications of this disease 
were made, as, for instance, external, internal, dry, humid, &c. 
Such classifications were of course defective, and it was left for 
that eminent dentist, M. Duval, to reform this. — He describes 
seven species or varieties of decay, which he calls calcareous, 
peeling, perforating, black, deruptive, stationary, and wasting. 

First Species. Calcareous Decay. — This decay presents a slight 
circular depression near the gum, where the enamel appears to 
be of a whiter colour than in its natural state, brittle, irregular 
resembling lime, and very sensitive. (PI. XII. Fig. 1.) It fre- 
quently occurs in youth, or in the course of severe inflamma- 

of the malady in these places has led many to suppose that it had its origin 
within their osseous structure. 

''But a still more absurd and ridiculous theory, in regard to the cause of 
the disease, is advanced by Mr. Charles Bew: he attributes it to the arrest of 
the circulation in the organ, ' by the lateral pressure of the teeth against 
each other.' 

" The exposure of the teeth, too, to sudden changes of temperature, as from 
heat to cold, or cold to heat, has been regarded almost from time immemo- 
rial as a cause of their decay; but no explanation of the manner by which it 
produced the disease was attempted, until the promulgation of the doctrine 
that it was the result of inflammation, when it was numbered among only 
the exciting causes. The popular belief that cold is a cause of dental caries, 
is traced back to Hippocrates, who in mentioning the parts of the body that 
are injuriously affected by it, includes the teeth." 

Delabarre, in alluding to this affection, observes: " Caries of the teeth is a 
disease of their tissue, and not a siinple decomposition proper to inert bodies. 
As an ulcer in a soft part is easily healed in a healthy subject, so the cure of 
this malady is effected with ease, in those of good constitutions. Caries, in 
individuals of different constitutions cannot be of the same nature, because 
their teeth have not the same solidity. Thus, those that are largel}' charged 
with gelatine will be exposed to odonto -ma/aria, whilst those in which the 
calcareous phosphate is present in large quantities, will not be attacked with 
it as long as they preserve this advantage. But absorption being effected in 
teeth as in other bones, (which their softening in the interior and below the 
enamel, demonstrates,j consequently it follows, unless some external agent 
may have had power to act on the osseous tissue, that we can estimate the 
qualities of the humours by the nature of the caries that is manifested in 
the teeth. 

"The softening of the interior tissue can result only from a derangement 
of the central ganglion; and this is caused by the arrival at this body of ar- 
terial blood deprived of the properties requisite to maintain it in a healthy 
state. 



82 



maury's dental art. 



tovy diseases: it is arrested by age, and the altered part be- 
comes yellow and sensitive. This decay may be the result of 
a congenital atrophy, or a blow upon the teeth. Its progress 
is slow, and art can afford no relief, except by widening the 
cavity to prevent the retention of viscous matter. It should 
be deeply cauterized"^ to dry up the soft parts and destroy its 
sensibility. Afterward, if the part be kept clean by means of 
a brush, we may hope to entirely destroy the disease, or at 
least to arrest its progress as long as the advice here given is 
followed. 

The incorrectness of the opinion advanced, by M. Belabarre that caries 
oF the teeth consists in something more than a mere composition of this 
tissue, has been shown in the fact that dead teeth decay as readily as living 
ones, and that caries in them exhibits the same appearances that it does in 
those that are possessed of vitality; and between the manner of the arrest of 
the progress of this malady, and that of an ulcer in soft parts, there is no 
more sameness than there is between the two diseases.- The cure in the one 
case is effected by the restorative powers of the body, whereas in the other, 
it is accomplished by the aid of art, the operations of the economy not con- 
tributing in the least to the restoration of the injury. 

"The reason of the difference in the nature of caries of the teeth in indi- 
viduals of different constitutions is, as M. Delabarre has justly remarked, be- 
cause of the difference in the density of the organs, which is determined by 
the temperament or state of the general health at the time of their formation. 
1 am compelled to differ with him in the opinion that softening of teeth that 
are not well provided with 'calcareous phosphate,' is owing to the removal 
of this earthy material by the absorbents, and that the disease is identical 
with that which, in other bones, is denominated moUities ossium. The action 
of the solvent agents that are concerned in bringing about that condition of 
the teeth designated caries, is facilitated by the softness of the organs, and 
hence the rapidity of decay in those that are of a very loose and spongy 
texture, and the rare occurrence of the malady in those that are endowed 
%vith great solidity. The decomposition, too, of their earthy salt is the more 
perfect, in proportion as they exist in small quantities. An impairment of 
the arterial blood, resulting from a ' disturbance of the central ganglion,' or 
any other cause, can have no agency in the decomposition or softening of 
the osseous structure of the teeth, except it gives rise to a morbid condition 
of the interior parietes of the salivary and mucous fluids of the mouth. The 
destruction of the interior parietes of a tooth never takes place while the 
pulp or central ganglion remains; but this sometimes inflames and separates, 
and gives rise to the formation of an acrid and very corrosive humour; and 
it is to the presence of this that the softening of the bone surrounding the 
dental cavity is attributable." — C.A.Harris on the Teeth, &c. &c. — S. 

* We have in a previous place given our objections to the use of the actual 
eauterj. — 



DENTAL PATHOLOGY. 



83 



Second Species. Peeling Decay. — The enamel, in the second 
species, which is nearly always accompanied by tetterous aJBfec- 
tions, assumes a yellow hue near the gum, becomes very brit- 
tle, and detaches itself from the tooth in small pieces. (PI. XII. 
Fig. 3.) The bony substance, at first yellow, and afterward 
brown, is soft, and may be cut away in layers, and is very sen- 
sitive where the enamel still remains. 

Third Species. Perforating Caries. — This kind of decay, the 
most frequent of all, shows itself indistinctly upon every part 
of the crowns of the teeth. The bony substance is often yellow 
or brown, softens, or becomes humid and fetid ; the cavity in- 
creases with greater or less rapidity, and communicates exte- 
riorly by a small opening. (PI. XII. Fig. 6.) It also often 
presents the form of a funnel, or that of a canal; the diseased 
walls are sensible to the slightest impression of cold or solid 
bodies; and whenever inflammation propagates itself to the 
bulb of the tooth, when the pulp is exposed, the pain becomes 
insupportable. The asseous part is gradually destroyed, and 
the enamel being thus deprived of its support, soon breaks into 
fragments; and finally nothing but the root remains, which 
ordinarily ceases to be painful. In such a case, if the nerve 
be not exposed, the tooth should be plugged, after having all 
the decayed part removed. But when the nerve is entirely 
laid bare there remains no other remedy, if it be a tooth that 
had two or three roots, but extraction, or excision of the crown. 
(PI. XV. Figs. 1, 2.) 

Fourth Species. Black Decay. — This species of decay is not 
observed until from the fifteenth to the thirtieth year, particu- 
larly in individuals disposed to rachitis or consumption. It 
usually commences in a blackish spot, (PI. XII. Fig. 4,) the 
circumference of which is of the same colour, and shows itself 
through the enamel, which at this point appears bluish, black- 
ens, and is easily destroyed. This black spot occasions a cavity 
in the bony substance, which becomes dry, brittle, black, ino- 
dorous, and insensible. The disease makes rapid progress, 
and usually stops when it has reached the root of the tooth; 
but it may be prevented by pursuing, according to the morbid 



84 



maury's dental art. 



condition of the tooth, the different procedures that I have in- 
dicated for other species of decay; that is, by plugging the 
cavity, or by eradicating with the file the whole of the dis- 
eased part, so that it may not exercise any influence upon the 
sound part. 

Fifth Species. DerupUve Decay. — This generally attacks the 
incisores of consumptive subjects. It manifests itself by a 
yellowish spot with destruction of substance near the neck of 
the tooth, and afterward extends itself obliquely and down- 
wardly toward the root, (PI. XII. Fig. 2,) by forming nearly 
always a semicircular brownish furrow. The osteo-dental sub- 
stance softens, and becomes sensible to the impression of heat 
and cold, and to the contact of acids and solid bodies. The 
disease makes great progress, and reaches the dental cavity; 
the tooth ceases to be sensible, and it sometimes happens that, 
the crown remaining entire, separates itself from the carious 
root. We may save a tooth affected with this species of caries, 
during the early stage of the disease, by filing all the decayed 
part in such a manner as to prevent the retention of any vis- 
cous substance. 

Sixth Species. Stationary Decay. — Each of the five kinds 
of decay of which we have spoken may be called stationary, 
when it isnot thought necessary to remove the discoloured spot, 
at each filing, to preserve the tooth, which has not really be- 
come decomposed. (PI. IV. Fig. 7.) The name of stationary 
decay has been applied more particularly to that species which 
attacks the enamel of the teelh, without altering the part which 
it covers. It develops itself all at once after severe consti- 
tutional indisposition, when convalescence has been very sud- 
den; under other circumstances, they are determined by a too 
great approximation of the teeth; but then it ceases to pro- 
gress, as soon as the space which separates them becomes 
wider, whether obtained by art or produced by the disease. 

Seventh Species. — Decay resembling Denudation. —This last 
species, difficult to discover at its commencement, because it as 
often presents the appearance of decay that has been sponta- 
neously arrested as that which is forming, has its seat upon the 



DENTAL PATHOLOGY. 



85 



grinding surface of the molar teeth. (PI. XII. Fig. 11.) It 

manifests itself by a deep or superficial depression, whose 
bottom is sometimes upon a level with the neck of the tooth. 
This cavit3^ is polished and single, oftener very yellow, but 
sometimes brownish, and the polish of its enamel may lead us 
to confound it with denudation of the teeth, if the inspection 
of the opposite teeth does not contradict this supposition.* 

The setting on edge of the teeth, and their sensibility and 
pain, are insufficient to characterize decay. We are, neverthe- 
less, often obliged to make use of the probe to assure ourselves 
of its existence whenever it has its seat upon the lateral sur- 
faces of the teeth or near their roots ; but in the majority of 
cases, simple inspection is sufficient to detect this disease. As 
to its prognosis, we perceive that it differs according to the 
number of the teeth that it afiects, the character that it pre- 
sents, and the nature of its causes. Hence in the treatment 
of caries in general, we should have two distinct objects in 
view, 1st, to preserve sound teeth from this disease, 2d, to 
remedy the disorders that have produced it, by endeavouring 
to entirely arrest their progress, by means of the remedies 
which we have indicated when speaking of each particular class 
of decay. f 

Destruction of the Roots of Teeth. — This disease often mani- 
fests itself in persons from forty to fifty years of age, of a bi- 
lious temperament; also, in persons whose constitution at this 
period of life undergoes a very great change; and we observe 
it too in certain women, still younger, whose health has be- 
come deranged after parturition. Its progress is slow, and 
only produces serious results after the space of two, three or 
four years. 

Destruction of the roots of the teeth is the result of decom- 
position of the substance that surrounds them. Its principal 

* Properly speaking, there is but one kind of dental caries, and the differ- 
ences in the appearance of this disease, as has been correctly described by 
Professor Harris in the quotation we have just made in a note, from his 
treatise on the "Characteristics of the Teeth, Gums," Slc.&c, are occasioned 
by the differences in the density of the teeth of different individuals, which 
determines the differences in their susceptibility of being acted upon by the 
causes that produced this affection. — S. 
8 



86 



maury's dental art. 



characteristics are, inflammation of the periosteum of the root^ 
and suppuration of the integuments that envelop it. This 
inflammation afterward attacks the alveolar border; the root 
then becoming a foreign body in the alveoli, is insensibly ex- 
pelled, or gradually consumed, and the dental nerve dries up. 

Loosening of the teeth, the destruction of their roots, and 
suppuration of the integuments that cover them, are seldom 
confined to a single tooth. (PI. XII. Figs. 7, 8.) These dis- 
orders may extend themselves to the neighbouring teeth, and 
very often cover the alveolar border of both jaws. 

This disease which, as is perceptible, is local in its commence- 
ment, but makes great progress, and may even attack the whole 
dental arch. A prudent dentist wall endeavour to save the 
patient from these disorders, and prevail upon him to submit 
to the extraction of the tooth over which there is the great- 
est discharge from the gum, by urging, that, as the tooth is 
loosened, the disease is local, and can be easily cured. When, 
however, the affection of which we are speaking has spread 
itself over both jaws, we may still hope to arrest it, or at least 
we may greatly retard its progress, by extracting from each 
jaw two or three of the teeth that have become most loosened. 
To neglect such precautions would be to leave in jeopardy the 
greater number of the teeth. We can derive no advantage 
from internal treatment; but we can abate the intensity of the 
disease by the employment of tonics upon the gums, and still 
more by the application of the actual cautery upon the prin- 
cipal seat of the discharge. 

Exostosis of the Teeth. — This disease is always difficult to 
discover before the extraction of the teeth. It affects only 
their roots in most cases; (PI. XII. Figs. 16 to 21,) but some- 
times only exists upon the side of the tooth. It presents a 
round and angular form, and under certain circumstances occu- 
pies the whole circumference and length of the root. (PI. XII. 
Fig. 17.) Under other circumstances it only constitutes a 
morbid condition, and sometimes is accompanied by encysted 
decomposition. This disease, which is nearly always the re- 
sult of engorgement and ossification of the dental periosteum, 
occurs particularly in subjects whose teeth have become pain- 



DENTAL PATHGLOGT. 



87 



ful, either in consequence of decay and denudation, or by the 
action of a gouty or rheumatic diathesis. 

It is aimost impossible to form a certain diagnosis of this 
disease. We may at most conjecture its existence from the 
heavy, dull pain that accompanies it, and the intensity of which 
is not always the sam.e; from swelling of the alveoli; from the 
mobility of the diseased tooth, which is not met with in all 
cases; and from the affected tooth no longer b^ing upon a level 
with the rest.* 

The sole treatment to be adopted upon the first appearance 
of this disease, consists in subduing the pain by emollient and 
narcotic topical applications, by local depletions, and revulsives. 
If the pain still exist, and the tooth becomes loose, its extraction 
is necessary. Fox speaks of a young lady who was obliged to 
have all her teeth extracted because their roots vfere affected 
with exostosis. 

Spina Ventosa.— This disease, which also attacks the roots 
of teeth, is very uncommon: it is analogous to exostosis, and 
presents similar symptoms and similar indications. The root 
is simply larger than usual; it is scooped out, its canal is very 
large, and its walls are very thin. 

JSTecrosis of Teeth — This affection differs but little from de- 
struction of the roots. It generally supervenes after suppuration, 
destruction, or disorganization of the alveolo-dental membrane. 
Although it is oftener the result of a chronic or gangrenous 
inflammation of the soft parts which are in connexion with the 
root of the tooth, it may also be occasioned by exterior vio- 
lence. Teeth affected with necrosis lose their natural colour; 
they become loose; sometimes they drop out; at other times 

* This aftection is supposed to be occasioned by an increased action of the 
vessels of the periosteum, and often occurs while the crown of the tooth is 
perfectly sound. This disease," says Dr. C. A. Harris, "often continues for 
a long time without producing any inconvenience whatever. It usually 
first manifests itself by a slight soreness in the affected tooth, which increases 
as the fang becomes enlarged, until pain, either constant or periodical, and of 
a character more or less severe, is experienced.'' 

If, from the dull heavy pain experienced in the tooth, we suppose its root 
to be affected with exostosis, we can but test it by tapping the side of the 
erown with a hard body., Severe pain at its root will indicate this afTection. — 



88 



maury's dental art. 



they remain in their sockets and occasion a fetid and purulent 
discharge from between their neck and the gums. After ex- 
traction, the root is seen to be reddish, yellowish, or blackish. 

Inflammation of the alveolo-dental Membrane. — {Periodontitis of 
Moderns.) This affection may be acute or chronic. When 
chronic, it produces destruction of the root. (PI. XII. Figs. 
10 and 13.) Whenever it is acute, it is characterized by pain, 
at first dull, and after acute and pulsating, although the tooth 
appears otherwise sound. The gum inflames, becomes red and 
painful, and sometimes the swelling is communicated to the 
cheek. This disease may terminate in resolution, or in the 
formation of an abscess. It is to be subdued by emollient and 
narcotic gargles, and by the application of leeches above the 
angles of the jaws: by pediluvia, and tepid and emollient 
drinks. 

When this disease passes to a chronic state, it is generally 
kept up by a constitutional cause, such as scrofulous, scorbutic, 
venereal, arthritic vices, &c. Then, as M. JNIarjolin remarks, 
it occasions between the teeth and the gums a fetid puriform 
discharge, which exposes the necks of the teeth and softens the 
gums. This affection is often very difficult to cure: the best 
local remedies, when the pain is slight or entirely absent, are 
bitter, astringent, stimulating, anti-scorbutic lotions, and fric- 
tions at least daily upon the gums and necks of the teeth, with 
a soft brush dipped in an astringent or bitter decoction. The 
application of leeches upon the tumefied gums, or scarifying 
them with the point of a lancet, will prove of advantage. 

This treatment should necessarily vary according to the 
cause of the disease; and it is often necessary to assist it by the 
application of a cataplasm behind the ears or neck. We may 
also employ the same treatment that we recommended in the 
disease that we treated of under the head of destruction of 
roots. 

Inflammation of the dental Pulp. [Odontitis of Moderns.) — This 
pain is generally more frequent among adults than children, 
and has its seat oftener in decayed than in sound teeth. It 
also happens more frequently wiien the decay approaches the 
dental cavity than when it has entirely exposed this cavity, 



DENTAL PATHOLOGY. 



89 



and when the teeth commence to be denuded, than when denu- 
dation has considerably advanced. 

This inflammation is particularly characterized by an acute 
pain, which increases when the sides of the tooth are struck; 
a pain which at first does not extend to the gums, nor to the 
jaw, but propagates itself there about the third day, if it does 
not gradually diminish. Then, all the nerves of the face par- 
ticipate in it. Sometimes, however, without assuming this 
character, it suddenly subsides, and the patient only feels a 
kind of numbness in the tooth. If, as it often happens, we are 
obliged to extract it, we will discover, by a careful examination, 
violent inflammation, suppuration, and gangrene of the pulp. 

Although the causes of inflammation of the dental pulp are 
very numerous, we may say that it is most particularly occa- 
sioned by violent ^impressions of heat and cold, by the least 
shock upon decayed teeth, by the retention or decomposition 
of portions of aliment introduced into the decay of the tooth, 
and finally by every species of disease. It may be sudden, 
slow, acute or chronic, continued or intermittent, with regular 
or irregular intermissions. 

The treatment of this disease is of that kind which is appli- 
cable to inflammatory aflfections, and should always have refe- 
rence to the causes that occasion it. This is the reason, that, 
after having perfectly removed the decay, if any exist, we may 
advantageously employ narcotics, such as the extract of opium, 
incense, myrrh, or other resinous gum. The nitrate of silver, 
the sulphate of potash, in small quantities, and covered with a 
piece of cotton introduced within the cavity, the concentrated 
acids, ether, or essential oils, may produce the same results. A 
piece of cotton is to be saturated in these liquids, and after 
having been placed in the cavity, a piece of dry cotton should 
be placed on it. 

The dental pulp is sometimes destroyed more promptly by 
cauterizing the decay with nitrate of silver or acids; but when 
the pulp of the incisores, cuspidati or bicuspides, is exposed, we 
can accomplish its destruction still better by means of a stylet 
heated to a red heat. 

In cases where there exists violent inflammation, it may be 
reduced, either by frequent emollient lotions kept for a time 

. 8* 



90 



maury's dental art. 



in the mouth, or by the application of leeches behind the ear, 
or a large plaster of the extract of opium, or by keeping the 
head and face very warm. In all these cases we should pre- 
scribe pediluvia slightly stimulating. 

As these various therapeutical means are not always suffi- 
cient to cure the disease, nor even to diminish the violent and 
insupportable pain, which, on this account, is called toothache, 
the only means left is the extraction of the tooth in which the 
disease is seated. 

Fungus of the dental Pulp. — This affection can only take 
place when the orifice of the dental canal is dilated by disease, 
or when the canal is accidentally exposed. In the first case, 
the tumefied pulp becomes larger and redder, and its pedicle, 
which is continuous with the alveolo-dental membrane, en- 
larges; in the last case, the tumefied pulp has exteriorly the 
form of a little red tumour, circumscribed by the border of the 
aperture of the tooth. This tumour is usually very sensitive 
to the touch; in some subjects it hardens and disappears. The 
disease is remedied either by excising or cauterizing the fungus, 
or finally by the extraction of the tooth, when all other means 
have failed. — {Marjolin.) 

Ossification of the dental Pulp. — This disease (says the author 
just quoted) presents two varieties. In a tooth affected by de- 
nudation, the pulp ossifies near the table of bone that still co- 
vers its canal. This ossification is a wise provision of nature, 
because it adheres to this table of bone, and increases its thick- 
ness. It often forms in decayed teeth a little osselet that rests 
suspended in the pulp, mentioned in our treatise on denudation 
of the teeth. 

Such are the diseases capable of affecting the dental sub- 
stance. We should here, perhaps, speak of some nervous 
affections of the teeth, and of odontalgia, properly so called ; 
but this latter affection is generally the sequence of other dis- 
eases of the teeth, and they will be treated of separately, after 
having pointed out the various affections of contiguous parts. 



91 



SECTION III. 

DISEASES OF THE TEETH RELATIVE TO THEIR CONNEXIONS. 

Loosening of the Teeth. — Loosening of the teeth may be con- 
sidered as an affection that depends more upon the condition 
of their own tissue than upon that of the parts with which 
the}^ are in connexion. It may be produced by several causes; 
some are external, others internal. The external causes are 
blows or falls; artificial teeth badly constructed, or improperly 
attached by clasps or ligatures to the neighbouring teeth; 
using without precaution a tooth as a fulcrum ; the accumula- 
tion of tartar upon the teeth, between the root and gums. 

The internal causes are the various alterations of the gums, 
in becoming soft and spongy from a scorbutic diathesis, the 
use of mercury, a rheumatic or gouty affection, and severe sick- 
ness. Sometimes they spontaneously become loose in old age, 
especially if they be long. 

Females, at their critical period, are often thus affected. I 
have under my care a woman, three or four of whose teeth 
became loose and dropped out together, at the period of cessa- 
tion of the catamenia. 

The means of re-establishing loosened teeth will be suggested 
by the cause of the affection. If the tooth has been acciden- 
tally loosened, the patient should be counselled to avoid using 
it in mastication, or disturbing it in any manner with his tongue 
or fingers. He should rinse his mouth several times daily 
with a tonic w^ash ; and also brush the teeth gently with a soft 
brush, in order to keep free from unwholesome accumulations. 

If the teeth have become loosened in consequence of the in- 
judicious application of ligatures or clasps, it will suffice to 
discard the use of these. If they be loosened from the effect 
of tartar, it should be carefully but promptly removed ; and, if 
the gums be not destroyed or much impaired, they will again 
adhere to the teeth, and render them firmly seated. The inci- 



92 



maurt's dental art. 



sores and cuspidati are more liable to loosen than are the mo- 
lares, in consequence of their greater length, as they are thus 
more seriously affected by their antagonists. In such cases, 
filing is indicated, by means of which they should be shortened, 
and thus their utility and beauty will be enhanced. 

When the teeth become loosened from an internal or con- 
stitutional cause, the remedy is more difficult, and the treat- 
ment then is within the province of the physician. Tonic 
lotions are here indicated ; but we should be very circumspect 
in the use of such as are astringent, and when we have recourse 
to them for the restoration of relaxed gums, it should not be 
until after all inflammation has subsided. 

Luxation of the Teeth, — This accident consists in the dis- 
placement of a tooth, which may be inclined outwardly, inward- 
ly, o^ laterally, and, at the same time, started more or less from 
its socket. It may be simple, or attended with contusions, 
wounds of the gums, fractures of the alveolar border, and even 
of the maxilla itself. The extent of such injury is always 
dependent upon the prior condition of the gums. Such luxa- 
tions are sometimes designedly effected by the hands of the 
dentist, as we shall have occasion to show in treating of opera- 
tions upon the teeth; but they are more commonly the results of 
falls, blows, &c. The incisores and cuspidati are more exposed 
to them than are the molares and bicuspides, from their posi- 
tion, as well as because of their being held by a single root 
each. Luxations may be complete or incomplete, and their 
treatment should properly be much more simple than many 
w^ould suppose. It consists in replacing in its primitive posi- 
tion the luxated tooth, and there retaining it by means of a 
ligature; but if, during the movements of the jaw, the tooth 
thus replaced should be interfered with by its antagonists, we 
should apply to the crown of one of the molares a platina or 
gold plate to prevent the jaws from approximating and thus 
again interfering with the injured tooth. 

The patient should take no aliment which, in its mastication, 
would do injury to the affected part. This precaution is of 
importance} and by attention to it, and the foregoing, ten or 



DENTAL PATHOLOGY. 



93 



twelve days will suffice for the luxated tooth to resume all its 
functions. 

This operation is very familiar to us, as we have often per- 
formed it in bringing into the dental arch irregular teeth that 
had grown inwardly or outwardly, or to retain decayed teeth 
that, having ached, were severed from their connexions, and 
replaced. Of a hundred facts, that are familiar to us, we will 
narrate but two having bearing upon this subject. The young 
Mazimbert, student at Dupras' institution, fourteen years of 
age, had in 1829 a central incisor that closed behind the inferior 
teeth, and which appeared so badly that he consented to have 
the deformity remedied. On account of the resistance of the 
alyeolar border, our movements were necessarily slow and cau- 
tious; but one of his companions, hastening to witness the ope- 
ration, gave our arm a sudden shove so as to cause us not only 
to break the external border of the alveolus, but also a greater 
part of the two adjoining alveoli. This tooth, as may be rea- 
dily presumed, was thus thrown completely out of its socket. 

This accident at first caused us some uneasiness, but our 
fears were soon dispelled upon inspection of the part. The 
tooth, adhering only to a portion of the fractured alveolus, was 
replaced, not in its primitive position, but in a range with its 
fellows, in such manner that the inferior incisores closed behind 
it. We employed no ligature to retain it in its new position. 
The patient was placed in the infirmary, and directed to use 
for several days a decoction of barley, and only such aliment 
as would be of easy mastication, and this in small quantities. 
We afterward substituted a healing and slightly stimulating 
lotion for the barley-water, and the patient eight days after re- 
turned to his duties, and scarcely had a month elapsed ere the 
tooth had become as firmly planted in its socket as any of its 
neighbours. 

When we reflect that at the age of fourteen the orifices at 
the extremities of the roots of teeth are capacious enough to 
admit of a free communication of the nerves, arteries and veins, 
we can well comprehend why this tooth did not change in 
colour as do those that are luxated at a later period of life, and 
which usually assume a yellow or dark hue.* 

* Luxation of the teeth is now recommended by no writer on dental sur- 



94 



mauiiy's dental art. 



The other case is that of a lady, aged forty-four, who had in 
the superior jaw only the two anterior molares. These served 
the purposes of mastication, and also to sustain artificial teeth, 
which she persisted in wearing notwithstanding the inconve- 
niences they occasioned her. One of these teeth became de- 
cayed upon its crown, and occasioned severe pain, which none 
of the remedies applied during three days could subdue. We 
proposed the luxation of this tooth, to which the patient ac- 
ceded; and after the operation had been effected, the artificial 
piece, sustained by means of these molares and a pivot, inserted 
into the fang of a central incisor, was replaced. We then 
plugged the decayed tooth. During the five years that have 
since elapsed, the patient has experienced no pain, and the ar- 
tificial piece no longer inconveniences her. 

Upon patients of indifi'erent constitution, and whose gums 
are turgid or continually engorged, luxating the teeth seldom 
results favourably. In such case recourse should be had to 
extraction of the tooth; particularly if it has been loosened 
and interferes with the movements of the jaw. 

gery, and as Dr. C. A. Harris very justly remarks, is practised by none but 
the ignorant or inexperienced. Dr. H. states that " Mr. Fox was the first who 
endeavoured to cure odontalgia, by raising the tooth sufficiently in its socket 
to break the vessels and nerves that enter the extremities of the fangs, and 
then immediately pressing it down again to its former position. His hopes 
of success were, at first, very sanguine. He thought that, if he destroyed 
the nervous connexion between a tooth and the general system, the tooth 
would not be liable to ache. The result of his operations disappointed his 
expectations; he found that, although the paroxysms of pain were not so 
violent as before, yet the tooth soon became sore, and protruded from its 
socket. He, therefore, never afterward performed the operation, except 
under the most favourable circumstances. 

"Subsequent experiments have not placed this operation in a more favour- 
able lighL The socket is generally much injured by the unnatural revulsion 
of the tooth, especially if it be one of the molares with its bifurcated fangs. 
An inflammation of the lining membrane and an effusion of the lymph follow, 
the membrane becomes thickened, and the tooth is in consequence protruded 
out of its socket, so that, at each occlusion of the jaw, it strikes its antagonist 
before the other teeth come together, and thus keeps up a constant irritation, 
and involves the adjacent parts in an unhealthy action. 

"My own observation," Dr. H. continues, "has convinced me that the 
chances of success for this operation, even under the most favourable circura. 
stances, are so uncertain that it ought never to be attempted." (Dental drt^ 
p. 174.;-S. 



DENTAL PATHOLOGY. 



95 



Loosening of the Teeth. — The teeth may become loosened 
from various causes, as by blows, falls, and other accidents, by 
disease, the habit of working them with the fingers, and by 
old age. When loosened by any accident they soon become 
tight again ; but if loosened by the effect of disease, they can- 
not be expected to adhere firmly again until health has been 
perfectly re-established. If loosened with the fingers, it will 
suffice to abstain from so pernicious a habit. The teeth of 
old men cannot be made firm in their places again, after be- 
coming loose, without great difficulty. They frequently re- 
quire to be shortened with a file that they may no longer be 
interfered with by those of the opposite jaw. 

A loosened tooth should -not be made fast to an adjoining 
tooth, for the purpose of restraining its motions, as that on 
which it may thus depend, will, in all probability, be injured 
in its position. It is better to carry the ligature to the second 
or third tooth from it. 

Replacement of the Teeth in their Sockets. — This operation 
consists in replacing teeth that have been extracted, and pre- 
sents chances of success more or less favourable, according to 
the health and age of the subject. It is also practised when a 
dentist unskilfully extracts one tooth for another, or wd:ien, by 
accident, the tooth has been knocked out. However simple 
this operation may appear, it requires precautions that cannot 
be too well attended to. Before attempting it, the mouth 
should be well examined. We annex a case in point. 

M. Puydebat, of Auch, our friend of the Royal Court of 
Agen, when fifteen years old, in attempting to mount an un- 
ruly horse, received a violent kick, by which three of his inci- 
sores, and one cuspidatus of the superior jaw, and two incisores, 
and two bicuspides of the inferior, were forced into his mouth. 
Falling upon his back, he remained nearly two hours insensi- 
ble. He lost much blood, and spat his teeth out upon the 
ground. Having recovered his consciousness, he returned to 
his farm, and, on the next day, was taken by his parents to a 
neighbouring town to receive such aid as could be procured. 
A physician, surgeon and dentist were consulted, the latter of 
whoin demanded the teeth, which were soon brought to him; 



96 



maury's dental art. 



he cleaned them, detached portions of the alveoli, still adhering 
to their roots, and replaced them in the mouth, in their respec- 
tive places. It may be easily concluded that portions of the 
fractured alveolar process still remained in the mouth ; and it 
will not, therefore, be a matter of surprise when we add that 
violent inflammation succeeded this operation, and before the 
fractured portions were detached, suppuration had occurred. 
The obliteration of the sockets succeeded this loss of substance; 
and the patient, after so injudicious an operation, was obliged 
to adopt a severe regimen, and, for eight months after, could 
take nothing but liquids. Two years later, as the teeth had 
not regained their primitive solidity, they were extracted, and 
his mouth was thus restored to perfect health. 

We should, in such cases, have regard to the age of the 
subject especially, and, previous to replacing the teeth, their 
crowns should be shortened. If as many as six or eight 
teeth have been knocked out, we should only replace four or 
five, choosing such as we think may be most likely to become 
firm again, permitting the alveoli of the others to become obli- 
terated, that those that have been replaced may be the more 
firmly fixed. Any splints that may be discovered previous to 
the operation should be extracted. If they be sufficiently large 
to impair the w^alls of the alveoli, we should hesitate to replace 
the teeth, for they never can become firmly seated. 

Dental Tartar. — Dental tartar is analogous to salivary concre- 
tions. It varies in colour as much as in consistency, which 
sometimes resembles a granulous pulp, sometimes a hard, cal- 
careous concretion, called coating or slime, according to its 
hardness. — Tartar may be yellow, gray, green, white, red, or 
entirely black in the mouths of persons who smoke tobacco. 
These varieties of colour depend, in a measure, upon the part 
of the tooth or gum that it occupies, the state of health of the 
subject, &c. The texture of tartar is commonly granulous; it 
does not present a regular organization, and may be compared 
to the callus that unites the fractures of bones. (PI. XIII. 
Fig. 9.) 

Tartar has been often analyzed by French and foreign che- 
mists, but difierent results have always been obtained. This 



DENTAL PATHOLOGY. 



97 



might be accounted for by the fact of its having been taken 
from different subjects; but we believe that tartar may be 
different in different parts of the same mouth. Be this as 
it may, it is now well known that the basis of tartar of the 
teeth resembles that of bone, but that it differs from bone in 
the species of animal matter that unites its parts, and which is 
analogous to mucus. Such are the conclusions of M. Vau- 
quelin and M. Laugier, published in an essay upon dental 
tartar, from which we extract the following 

1. This matter, reduced to fine powder, loses seven hun- 
dredths of its weight of animal matter by desiccation. 

2. Dissolved in muriatic acid, it leaves thirteen hundredths 
of its weight of animal matter of a yellowish white colour. 

3. This animal matter, submitted to the action of boiling 
water for at least two hours, does not dissolve, and the decoc- 
tion, reduced to the smallest quantity, does not give the slight- 
est trace of gelatine. This result proves that the animal matter 
is not the same as that which exists in bones. 

4. The phosphate of lime, precipitated by the ammoniac of 
its muriatic solution, becomes yellow after desiccation, which 
evinces the presence of a certain quantity of animal matter. 
This phosphate becomes black when heated in an enclosed 
crucible. In this state its weight equals that of seventy per 
centum -of the tartar employed. 

5. In the liquor in which the phosphate of lime had been 
separated, we put oxalate of ammonia. The precipitate thus 
produced, formed twelve per centum of the weight of the tar- 
tar used, and represented about nine per centum of the carbo- 
nate of lime. 

6. The results obtained in the above operations did not 
represent the precise quantity of matter submitted to the ana- 
lysis, and we evaporated the liquid in which the phosphate and 
carbonate of lime had been precipitated to discover if it con- 
tained any particles of animal matter. The muriate of ammo- 
nia, dried and heated slowly in a platina crucible, became 
black, and, being consumed, left a brown substance weighing 
three-fifths of a grain, which resembled the oxyde of iron, an4 

9 



98 



MxVury's dental art. 



which was in fact composed of lime and phosphate of mag- 
nesia. 

7. A fragment of tartar, exposed to a strong heat for about 
one hour, became perfectly white, and lost 22.6 per centum. 
Allowing seven per centum for the evaporation of moisture, 
we will then have 15.6 of animal matter, presuming that the 
carbonate of lime has not been decomposed in the operation. 

8. A tooth covered with tartar, having been perfectly- 
cleaned, and afterward heated until it had become white, lost 
33.2 per centum. Thus, supposing that this tooth contained 
the same quantity of water as the tartar, it possessed a greater 
quantity of animal matter, since the tartar only contained 15.6 
and the tooth 26.2. This is without doubt the reason why 
the teeth are harder, and have more consistency and elasticity 
than the tartar which covers them. 

9. Although the small quantity of tartar of the teeth upon 
which we have experimented, has left us but little hope of 
discovering in it the presence of the phosphate of magnesia, 
we have analyzed 1.77 gr. of that substance by sulphuric acid 
after the manner heretofore indicated, and we have obtained 
fifteen milligrammes of phosphate of the ammoniac of magne- 
sia, which represented 1.18 of the substance experimented 
upon. 

Desiring also to ascertain if tartar of the teeth contained uric 
acid, or urate, we put a certain quantity of it into a solution of 
potash; but discovered nothing of the kind. 

By this analysis, one of the most perfect recorded, it is shown^ 
that this substance is composed, 1st, of animal matter, differing 
from that which enters into the composition of bones; 2d, of 
organic matter, 3d, of the phosphate and the carbonate of lime; 
and, 4th, of a brown substance resembling the oxyde of iron, 
and formed of iron and of phosphate of magnesia. 

Authors do not agree upon the manner of the formation of 
these various kinds of dental concretions. Without recapitu- 
lating hypotheses more or less ridiculous, I will state that the 
opinion most generally received is, that it is produced in part 
by a pathological secretion of the gums, and in part by a kind 
of deposite of the saliva and other fluids that moisten the 
mouth. 



DENTAL PATHOLOGY. 



99 



Every one knows with what facility tartar accumulates upon 
the teeth. It at first has a viscid and slimy appearance, and 
augments upon their crowns chiefly during sleep, forming it- 
self into layers, which harden one after another, and adhere to 
the teeth like successive coats of mastic. It usually envelops 
the base of the teeth, accumulates in the intervening spaces, 
fills their interstices, and penetrates as far as their roots in the 
alveolar cavity. 

When only one side of the mouth is used in mastication, 
and the teeth are not carefully attended to, tartar will constantly 
accumulate upon the teeth thus thrown into disuse. 

Among persons whose principal nourishment is easily mas- 
ticated, the teeth soon become covered with tartar resembling 
very thick cement, in consequence of there being little friction 
in the process of mastication. But the most certain preventive 
is the constant use of the tooth-brush. 

Tartar forms upon the teeth of all persons, but not uniformly. 
The quantity always depends upon the temperament, condition 
of health, or peculiar idiosyncrasy of the mouth. Upon the 
teeth of some persons its collection is very slow, while the ut- 
most efforts of others will be necessary to prevent it. The 
teeth of individuals have been seen so completely incrusted 
with it as to have the appearance of one solid piece. (PI. XIII. 
Fig. 9.) Examples of this kind are very common; but it is 
observed that persons whose teeth are most liable to such in- 
crustations are of a pituitary, delicate and mucous constitution, 
whose mouths are constantly bathed with an abundance of 
viscid saliva, and whose gums are pale, soft, of a dull red, or 
livid and turgid aspect. Climate also influences this formation, 
and it is not so frequently met with upon the teeth of persons 
inhabiting warm or temperate climates as upon those who in- 
habit marshy and humid regions. It rarely exists upon the 
teeth of children of good health and constitution, and still more 
rarely upon the teeth of persons from twenty-five to thirty 
years old; but it is often met with in persons of advanced age 
whose teeth are apt to be so completely covered with this 
earthy concretion as to present a disagreeable and ofiensive 
appearance. 

Next to the ravaging efiects of caries of the teeth, tartar is 



100 



maury's dental art. 



the chief agent in their destruction. By increase of volume 
and from its hardness, the cheeks, lips, and even the tongue, 
are often irritated by the presence of tartar ; it corrodes and 
chafes the gums, and renders them liable to bleed upon the 
slightest touch. Fluxions, from which engorgements proceed, 
with a purulent discharge, imparting to the breath an offensive 
odour, may also be occasioned by the presence of this substance. 
M. Duval asserts that he has seen these ulcers, when neglected, 
pass into a state of gangrenous mortification, which, extending 
itself over the gums, necrosed the subjacent maxillary bones. 
He has also known tartar so to irritate the gums as to occasion 
a gouty and rheumatic affection, and become the cause of pain, 
loosening of the teeth, and their ultimate loss. 

Independently of the disorders we have mentioned, and 
which depend less upon the quantity of tartar accumulated than 
upon the depth to which it penetrates into the alveoli, irritation 
in the glands and salivary conduits, of a serious nature, may 
proceed from its presence. An abundant flow of saliva also 
proceeds from this cause, and, being carried into the stomach, 
gives rise to unpleasantness of feeling analogous to the symp- 
toms of real disease, and tends to impede digestion. These 
symptoms disappear as soon as the foreign matter has been re- 
moved from the teeth. 

From the evils described as attendant upon the presence of 
tartar, it will readily be acknowledged that to prevent its ac- 
cumulation, is a duty of no little importance. — This m.ay be 
effected by a proper regard to cleanliness. Water, to which a 
few drops of spirits may be added, is a good lotion. It should 
be applied with a brush and suitable dentifrice. These means 
will suffice unless the deposite has already become hardened, 
in which case the aid of the dentist should always be sought, 
as its removal will now require care and skill, of which we 
shall have occasion to speak in describing the manner in which 
this operation should be performed. We need hardly remark 
that the use of acids should not be resorted to in such a case. 
They are always injurious, for the tartar cannot more readily 
be affected by them than can the enamel or bony substance of 
the tooth itself. 

Our remarks upon the diseases of the teeth might here ter- 



DENTAL PATHOLOGY. 



101 



minate, but that the sabject of toothache has not hitherto been 
spoken of. This affection is allied to alKof the preceding, but 
for the sake of perspicuity we deem it better to treat of it . 
separately. In doing so we shall place ourselves under obliga- 
tions to Dr. Merat, whose excellent article in the thirty-seventh 
volume du Dictionnaire des Sciences MedicaleSf we shall make 
free with. 

Odontalgia, or Toothache, is a peculiar pain, and may be re- 
garded as one of the most frequent and distressing aflections 
to which we are liable. It spares neither infancy nor age. In- 
deed, before their appearance above the gums, the teeth pro- 
duce pain, and at the period- of their protrusion, convulsions 
and even death, proceed from them. It would seem that bones 
so hard, and of a structure so well organized, might be pre- 
served from pain; yet these, of all the bones of the human 
system, most frequently present this phenomenon; but, we 
again remark, there are few affections of the teeth that are 
not accompanied with pain, and this may be occasioned not 
only by the disease of the tooth itself, but also by affections 
of the adjacent parts, and by exterior causes. 

Pain occasioned by Disease of the Tooth- — This is the most 
common description of toothache, and may proceed from a 
fracture or inflammation of the dental tissue, but more usually 
from decay of the organ. 

Pain proceeding from Disease in the surrounding Parts. — This 
may derive its origin from all or any of the morbific conditions 
of the gums, alveolo-dental nerve, and even other parts of the 
mouth and face. 

Inflammation, caries, and all other lesions of the alveoli, 
may determine it either by acting sympathetically upon the 
tooth through the medium of vessels and nerves, or by com- 
municating to it the disease. As no external sign can be per- 
ceived, we are often ignorant of the source of pain, at least at 
its commencement, and it is not until after the extraction of 
the tooth, which is found to be in health, that we can ascertain 
the real cause of the affection. 
9* 



102 



maury's dental art. 



The dental nerves are sometimes subject to acute pain when 
there is no inflammation or alteration of the bony tissue; and 
this aflfection, which is called dental neuralgia, is very frequent. 
It differs from inflammatory odontalgia b)- the absence of pain 
and pulsation in the part, and is never followed by abscess. 

Other parts of the mouth may also occasion toothache, by 
displacing the tooth, as in exostosis, abscess, polypi, &c., or 
by extending to them the disease of which they are the seat, 
as in cancer, caries, rachitis, &c. 

Pain in the Teeth from exterior Causes. — This pain may pro- 
ceed from affections of different parts of the organism, as rheu- 
matic, gouty and erysipelatous vices affecting a portion of the 
dental arches; or it may result from an entire exterior cause, 
as the contact of very cold or hot air, or frequent mastication 
of acid or sweet aliment. In the first case the pain is not cir- 
cumscribed, but may affect the entire jaw; in the second case 
we may experience less pain, but it is of a peculiar character, 
and has been denominated setting on edge. 

We can cite numerous examples of periodical toothache, 
symptomatic of affections, of other and remote parts in which 
such affections have not in an immediate manner developed 
themselves. Hence an individual may often experience pain 
in one tooth while the cause exists in another; and thus the 
unaffected tooth has often been extracted. Indeed persons 
have been known to point out one jaw as the seat of pain 
while the malady existed in the other, and over the right in- 
stead of the left side. Sometimes, also, violent pain is felt 
where no decay whatever exists in the teeth ; but this usually 
is in consequence of disease in the alveoli and periosteum. 
Hence it will be perceived how important it is that circum- 
spection should be exercised in the application of remedies. 

The Means of remedying Pain in the Teeth and surrounding Parts. 

The remedies should be directed to the first cause of the 
disease. When, for example, it is occasioned by first dentition, 
we should, as far as possible, facilitate the dental eruption, 
first, by softening the gum and diminishing its thickness; se- 
condly, by endeavouring to alleviate the local plethora by the 



DENTAL PATHOLOGY. 



103 



means pointed out in our remarks upon first dentition. Vesi- 
catory applications will also be of advantage in cases of san- 
guine turgescence. 

When toothache is produced in adults by inflammation of the 
dental pulp or the alveolus, we should have recourse to the ap- 
plication of leeches, fumigation with a decoction of elder, emol- 
lient lotions, stimulating pediluvia, and cooked figs applied 
to the gums. If the pain be more especially experienced at 
night, it will be proper to foment the afiected part of the head 
for about twenty minutes with hot flannels steeped in a decoc- 
tion of camomile flowers, in which two or three poppy heads 
have been boiled. We should always endeavour to avoid the 
application of cataplasms upon the cheek, as, should an abscess 
form, that application will cause it to open exteriorly. Where, 
however, the judicious application of these several means proves 
unavailing, the tooth should be extracted, but not until the in- 
flammation has disappeared.* 

Dental neuralgia, of which we have spoken, should be treated 
with anti-spasmodic and sedative applications. The pain 
usually attends the course of the nerves, and violently affects 
the head and ears. It may be subdued by derivatives and 
emollients. Some surgeons have been successful by means of 
the application of moxa over the mental foramen, and by section 
of the nervous branch which ramifies to the teeth. We have 
sometimes relieved this affection by the application of small 
vesicatories or plasters, prepared with the extract of opium, to 
the temples, or behind the ears. These should be about half an 
inch in diameter. f 

* It is improper to await the subsidence of the inflammation ere we extract 
the tooth. Its extraction is a means of producing this effect. — S. 

t Mr. T. Bell, who, it seems, has paid much attention to this aflfection, says: 
" from the considerable attention paid to the different forms of the complaint, 
I have long since come to the conclusion that tvyo distinct affections — dis- 
tinct in their causes, and equally so in the effect which different remedies are 
found to exert upon them — have been confounded under these terms ; the 
one constitutional in its cause, and curable by general remedies ; the other 
local, which, though occasionally relieved to a certain degree by such treat- 
ment, can only be permanently cured by the removal of the local cause* 
which, unhappily, often lies too deep to be within the reach of any ope- 
ration. 

It must be confessed that the symptoms of these two affections are so 



104 



maury's dental art. 



Odontalgia most frequently results from caries of the teeth, 
and from portions of these organs being permitted to remain in 
their alveoli. If the pain be severe, and the decay has extended 
to the dental nerve, extraction is the proper remedy. If, on 
the contrary, the decay be small, we should have recourse to 
milder remedies, as the pain may in such case originate from 
the effects of heat and cold upon the general system, or upon 
the tooth itself. 

Odontalgia, when merely indicative of rheumatic affections, 
the puerperal state, &c., falls more properly under the cogni- 
zance of the physician than that of the dentist. 

similar as to be readily confounded, and perhaps it would be difficult to lay 
down any one character which should infallibly distinguish the one from the 
other. There are, however, some general diagnostic symptoms, which, after 
having seen many cases, will, 1 believe, enable the practicien to decide 
with considerable certainty in any well-marked case. 

"In those which have a constitutional origin, periodical returns of the 
paroxysms are, if my view be correct, an invariable symptom. This may 
vary to a great extent, not only in the degree, but also in the regularity 
which may characterize the exacerbation of pain. In some cases the pain is 
incessant, and almost always equally severe ; and it is only by careful atten- 
tion that its periodical increase can be ascertained. In others, not the 
slightest painful sensation is perceived during the twenty-four hours, with 
the exception of a distinct and certain period, which never fails, and never 
varies, and during which, perhaps, the agony is intense. 

" In the local disease, on the contrary, the pain is either continual, with- 
out any marked paroxysms of increased suffering; or the attacks are sudden, 
frequent, and interrupted by intervals of perfect ease, but recurring from 
time to time, and, in both cases, without any regular periods. This is the 
most obvious diagnostic character which has appeared to me to distinguish the 
two diseases. Farther observation may, perhaps, enable us to add other and 
more certain marks of distinction ; but even this will, as I, believe, be found 
generally sufficient to indicate the nature of the disease." 

This disease is not confined to any one part of the body. The branches of 
the fifth pair of nerves are the most subject to it. After regulating the 
bowels, if requisite, with some mild purgative, the administration of the 
sulphate of quinine, and the arsenical solution alternately, will be found to 
effect a cure. 

Local neuralgia is a disease, produced by local irritation, as exostosis of the 
roots of teeth, &c. On the extraction of such teeth, the affection immedi- 
ately disappears. Mr. T. Bell says he has employed the following prepara- 
tion with great success: 

R. Hydrarg. Oxymur. ^i. 
Unguent. Cetac. §i. 
Misce, fiat linimentum. 
The side of the face to be rubbed with this lotion.— S. 



DENTAL PATHOLOGr. 



105 



Although many substances have been discovered capable of 
mitigating the sufferings produced by toothache, or of curing 
it, we are nevertheless constrained to confess that there exists 
no specific for it. We may, however, produce momentary 
abatement by cauterizing the teeth, applying alcohol, sul- 
phuric ether, essential oils, emollients, anodynes, and narcotics 
generally. 

Very often the most severe pain will yield to the applica- 
tion of a little cotton saturated with essential oil, and intro- 
duced into the decayed cavity of the tooth. The annexed 
formula is the prescription of Dr. Handel, of Metz, and is an 
excellent antidote to toothache. 

Opium, ^ drachm. 

Oil of Henbane, ] " 

Extract of Belladonna, ....■) ^ . , 
^ „ _ , ' > D grams each. 
JiiXtract of Camphor, ) 

Oil of Cajeput, •••••• \i ounce and 6 grains each. 

I'lncture of Oantharides, . . ) 

An opiate of this kind is particularly applicable to odontal- 
gia having its seat in the superior jaw, as it can be placed im- 
mediately to the seat of the disease, which could not be done 
were a liquid employed. Small pills, composed of opium and 
camphor, may also be advantageously employed; and we have 
used, with success, our soothing pills, composed of equal parts 
of the resinous extract of opium, camphor and incense. 

The composition known as soothing drops, the formula of 
which we annex, is one of the most efficacious remedies we 
know of fer toothache produced by caries of the teeth, or other 
affections of the mouth. It should be applied as follows: 
First, the cavity of the tooth should be cleansed with a piece 
of cotton, and then another piece, saturated with one or two 
drops of this liquid, should be introduced. If inflammation 
has proceeded from the affected tooth, cataplasms, composed 
of flour of flaxseed, and a few poppy heads, and from fifteen 
to twenty of these drops, should be applied to the cheek of thie 
patient. This dressing should be removed every three hours. 
If the gums only are inflamed, a gargle should be used, composed 
of a table-spoon twice full of barley-water, and from six to 
eight of these drops, from which relief may be expected. It 



106 



maury's dental art. 



should be used several times a day, and retained in the mouth 
three or four minutes at each time. 

SOOTHING DROPS. 



Alcohol, 3 ounces. 

Sulphuric Ether, 1 " 

Tincture of Opium, 1 " 

Turlington's Balsam, 3 drachms. 

Essence of Cloves, 3 " 

Misce. 



This liquor should be kept in a vessel hermetically sealed. 

The use of the magnet has also been proposed to relieve 
toothache. This remedy, though innocent, does not appear to 
merit the credit which the Abbots Lenoble and Lepelletier 
seemed anxious to attribute to it. We can hardly believe that 
the magnetic properties of any instrument, placed in contact 
with the teeth, can have any salutary effect upon a diseased 
nerve. 

Electricity has also been recommended as a cure or pallia- 
tive in this affection, but our experience has not enabled us to 
offer an opinion upon its merits. We may, however, remark 
that this kind of treatment is at least of uncertain efficacy, 
and that it is but seldom used, since the pain it occasions 
is nearly as acute as that resulting from the extraction of a 
tooth. 

The imagination of some individuals is sufficiently powerful 
to control the most distressing toothache. We have seen vio- 
lent mental emotion in persons of nervous susceptibility, pro- 
duce a similar effect. How can we, without attributing it to 
the imagination, account for the instantaneous cessation of 
toothache that many persons experience on approaching the 
door of the dentist ; and also the effect of various charms, and 
certain prayers, the efficacy of which depends entirely upon 
the confidence reposed in them ? 

The following circumstance, which we witnessed in London, 
in 1825, will tend to show how far credulity may be taxed when 
a person is persuaded that certain means, no matter how ridi- 
culous, are sufficient to accomplish a cure. On passing one 
morning through one of the most populous streets of that city, 
(Newgate street,) we perceived in the midst of a crowd a 
gibbet, on which a man had, half an hour previously been 



DENTAL PATHOLOGY. 



107 



hanged ; and, to our great astonishment, we saw the hangman 
pass one of the hands of the corpse over the neck, stomach, 
back, and mouth of a young woman. On inquiring into the 
import of this, we were informed that she would thus be 
cured of pain in the breast and toothache. We should not 
have believed this report had we not seen the woman raise the 
hand of the dead man after the executioner had let it fall, and 
repeat the ceremony. 

It will not be profitable to enlarge farther upon the means 
recommended for the cure of toothache. Their enumeration 
would occupy too much space. Every person can tell of some 
remedy, which, under some circumstance, has benefited him. 
We are, however, far from objecting to those means that have 
been called women's remedies; and, if they are not capable of 
injuring the teeth or gums, it is unwise to forbid them. If 
they be employed, time will thus be gained, and the affection 
will often subside of itself. The pretended specific will, of 
course, be accredited. 

We have thus pointed out most of the diseases of the dental 
organs, and if we are limited in our enumeration of the various 
therapeutical, general, internal, and operative remedies called 
for, it is only to avoid fastidious repetition; our intention 
being hereafter to detail the various modes of preserving the 
teeth, the operations they require, and the different procedures 
to which the dentist has daily recourse to replace them. 

The order adopted in this work places us under the neces- 
sity of treating of such of the parts of our organism as have 
any immediate connexion with the teeth; hence we shall speak 
of the gums and their principal morbid affections. 



THE GUMS, AND THEIR VARIOUS MORBID AFFECTIONS. 

The gums, firm and of a rosy white in a healthy state, 
polished and smooth in infancy, festooned in adolescence, 
hard and resisting in old age, are subjected to certain morbid 
affections which are peculiar to them, and which sensibly 
change their appearance. They inflame, tumefy, and even 
excoriate, under certain circumstances; and often become the 



108 



maury's dental art. 



seat of violent phlegmasise, aphthae, pains, excoriations, fistules 
and ulcers. They may also waste away in such manner as to 
expose the alveolar borders; or they may be so engorged and 
swollen as to occasion fleshy excrescences which are often 
diiScult to cure. Such are the different morbid conditions of 
the gums, and which we now purpose examining. They form 
according to Dr. Aubry, three principal divisions, under th^ 
general terms, inflammation, swelling, ulceration, and fungus of 
the gums. 

The first of these divisions embraces aphthce, inflammation at 
the period of first dentition, abscesses, phlegmons, dental fistules ^ 
and adhesion of the gums to the cheeks. 

The second shall include remarks upon scorbutic affections, 
scurvy of the gums, their gangrene, and the various alterations 
produced by scrofula, syphilitic virus, and the use of mercury. 

In the third division we shall describe epules and other 
fungous tumours of the gums of the same class. 



SECTION I. 

inflammation of the gums. 

Aphthce. — This affection is characterized by a white, tuber- 
culous eruption, superficial or confluent, which developes itself 
upon the interior of the mouth, and sometimes extends deeply 
into the oesophagus. It should not, properly, be classed with 
the diseases of the gums, as it only affects the buccal mem- 
brane which invests them. The pustules are so numerous as 
sometimes to impede respiration, mastication, and deglutition. 
Their presence often occasions an involuntary flow of saliva. 

In adults, aphthae generally have the appearance of small, 
white tubercles, superficial, round, of the size of a mustard 
seed, scattered in different pustules, or united in such manner 
a^ to form a thick crust. They may be transparent, opaque, or 
of a livid, black, or yellow colour. They seldom occasion dis- 



DENTAL PATHOLOGY. 



109 



order of the general system. In children, however, their ap- 
pearance is regarded more seriously; they are often preceded 
by impaired digestion, anguish, heat, frequency of the pulse, 
sleeplessness, and convulsive agitation of the muscles of the 
face. These pustules have the appearance of small, distinct 
white buttons, separated by uninflamed intervals, and at first 
occupy that part of the gum through which the incisores are 
about protruding, and thence extend themselves to the com- 
missures of the lips, the internal face of the cheeks, the tongue, 
and the palate. There is but little heat in the diseased part. 
At the end of a few days they become yellow, and drop off 
about the ninth or tenth day, but again appear, and sometimes 
are reproduced upon the internal membrane of the mouth. 
Such is the character which aphthse sometimes present, but, 
unfortunately, they do not always exhibit so mild a nature. 

When the pustules are confluent, the buccal inflammation is 
more intense; and they exfoliate only to be promptly repro- 
duced. The mouth is burning, and can scarcely bear the im- 
pression of soothing liquids, so acute is the pain. The disease, 
under some circumstances, assumes a still more serious charac- 
ter; there is then difficulty in swallowing and breathing, the 
breast becomes heated, the voice hoarse, the mouth dry and 
interiorly covered closely with pustules. At other times a 
crust resembling coagulated milk is formed by the pustules. 
The volume of this crust rapidly increases and assumes a yel- 
low or brown colour; an eschar is soon formed, the destruction 
of which exposes a brownish red ulcer, with a fetid sanies, 
which, when deep-seated, may terminate in gangrene, and some- 
times in death. 

This afiection is always serious in young subjects, though 
not usually fatal. In adults it is less severe. 

At all periods various opinions have been entertained as to 
the true cause of this disease. It has been observed to be most 
frequent in the latter part of autumn. Low and humid loca- 
lities are favourable to its propagation; it is very common in 
Denmark, Holland, and Zealand. Individuals most subject to 
these eruptions are children and old men of lymphatic and 
feeble constitutions; and, also, persons subject to catarrhal af- 
fections, whose teeth are decayed, or covered with tartar, &c. 
10 



110 



maury's dental art. 



Habitual filthiness, use of bad aliment, defective lactation, in- 
considerate use of mercurial preparations, very hard aliment, 
or asperities in the mouth occasioned by decayed or fractured 
teeth, are causes favouring the development of aphthte. Under 
some circumstances, however, it assumes an epidemic character, 
especially in hospitals for infants. 

The treatment of aphthae, for which the dentist is frequently 
consulted, should entirely depend upon the cause originating it. 
Thus, in sparse aphthae of children and adults, it will suffice to 
preserve them from morbific influences so that the eruptions 
may of themselves disappear. Soothing gargles, slightly aci- 
dulated, and emollient drinks, are the sole means indicated for 
adults; the milk of a healthy nurse is the best remedy for chil- 
dren. 

If the aphthae are confluent, the diseased parts should be 
touched with a brush dipped into a liquid containing sulphuric 
or hydro-chloric acid. 'J he neck and head should be kept 
warm; lime-water and a decoction of bark should be used as 
a drink. When deglutition is difficult, we should substitute 
for these drinks gargles, injections, and medicated baths. If 
the eruptions depend upon asperities of the teeth, these should 
be promptly removed with a file. 

Phlegmasia resulting from the Perforation of the Gums at the 
Period of Dentition. — We have already treated of plegmasia, in 
speaking of the phenomena that occur at the period of first 
dentition. We then witness inflammatory symptoms so in- 
tense as to involve the face and submaxillary glands, and which 
progress so far as to produce the most serious consequences. 
The maxillary bones themselves may be attacked, and the com- 
plete destruction of the gums of the permanent teeth may re- 
sult therefrom. 

The pain resulting from this buccal phlogosis may only be 
alleviated by the milk of the mother, which possesses a two- 
fold advantage, by appeasing the thirst of the child and soft- 
ening the tissues of the gum, and thereby removing in part the 
resistance presented to the approaching teeth. When this 
remedy may not be had, recourse should be had to mucilages 
of flaxseed, gum Arabic and marsh-mallow, to which should 



DENTAL PATHOLOGY. 



Ill 



be added a little honey. This may also be applied to the gums 
by means of a brush made of a piece of the root of marsh-mal- 
low. If the inflammation be very great, the above remedy 
should be persisted in, and, if possible, the milk of a healthy 
nurse should be procured. 

When, however, the gum offers an obstinate resistance, we 
should, with the instrument represented in (Plate XIV. Fig. 
4,) make an incision down to the tooth. The hemorrhage that 
may result from this should give no alarm, as it tends to allay 
the inflammatory symptoms. Should it, however, appear too 
copious, it may be arrested by oxycrate lotions or acidulated 
water. 

The child that has escaped the evils of first dentition may 
yet be less fortunate in the process of second dentition. The 
tissue of the gums at this period, more firm and compact, pre- 
sents greater resistance to the tooth that presses against it. 
The swelling is considerable, the part appears very red, and 
the pain becomes excessive. This especially occurs at the 
time of the eruption of the inferior permanent molares, and 
the inflammation may be so intense as to produce abscesses of 
a serious character, particularly should they be developed ex- 
t;ernally. 

These evils may be most effectively remedied by scarifica- 
tion, or the removal of portions of the temporary teeth that 
may have occasioned them. The latter operation may be 
easily accomplished, as these teeth are at this time usually 
necrosed or partially absorbed. 

Baths, stimulating pediluvia, diluent drinks and relaxing 
gargles, are generally indicated by such alarming symptoms^ 
which often do not of themselves recede. 

Phlegmon, or Mscess of the Gums. — It is notunfrequently that 
phlegmons or abscesses succeed severe inflammation of the 
gums, and these sometimes terminate in resolution, at other 
times in suppuration, but at times also they assume a more 
serious character. These inflammatory tumours have been 
called parules, or abscesses of the cheek, and are so often wit- 
nessed in practice as to be easily recognised. They may 
result from a peculiar constitutional vice, a rheumatic affection, 
inflammation of the tissue proper of the gums, and caries of 



112 



mattry's dental art. 



the teeth, maxillary bones, &c. They may likewise arise from 
an acute disease of the alveolo-periosteum, rupture of some of 
its fibres, from contusions, blows and pressure upon the gums, 
or from irritation of the dental nerves communicated to the 
teeth. They may also emanate from sudden impressions of 
heat or cold, from the accumulation of tartar upon the teeth 
and gums, the inconsiderate use of mechanical agents, elixirs 
badly prepared, and many pretended specifics that are highly 
extolled as means of re-establishing loosened teeth. The im- 
proper manner of plugging teeth, and the insertion of several 
artificial teeth at a time upon pivots, may also produce them. 
These tumours are most commonly developed in the vicinity 
of carious teeth, and more frequently near the anterior than 
the posterior portion of the mouth. The neighbourhood of 
the superior incisores is especially exposed to them. Some- 
times the disease only consists of a pustule situated upon the 
gum, and which developes itself in twenty-four hours; at 
other times it consists of an enormous deposite disfiguring the 
entire side of the face, and which suppurates at the expiration of 
some weeks. 

In all cases they are preceded by painful tension of the af- 
fected part, which gradually swells and reddens. The opposite 
jaw soon participates in this swelling, and extreme heat and 
sensibility are manifested here, which are greatly augmented 
by the movements of the jaw. If this phlegmasia is very ex- 
tensive, or if it be developed with rapidity, it soon occasions 
general derangement; it produces cephalalgy, horripilations, 
sleeplessness, acceleration of the pulse, and other symptoms of 
fever. The swelling extends itself to the head and ears; there 
is difficulty in opening the mouth, impediment in speech and 
mastication, and the saliva is secreted in greater abundance 
than in a healthy condition. After some days the inflam- 
mation may gradually disappear, especially if there be no con- 
tinued cause, as the presence of a decayed tooth or root, 
disorganization of the maxillary bone, &c. It in this case ter- 
minates by resolution, particularly if, on its first appearance, 
emollient topical applications have been made, together with 
suitable revulsives, gargles composed of milk, or marsh-mallow 
water, healing infusions slightly stimulating, &:c. By means of 



DENTAL PATHOLOGF. 



113 



these remedies the inflammatory symptoms abate, the functions 
of the mouth are restored, and the patient experiences entire 
repose. 

Should the disease, on the contrary, tend to suppuration, 
the progress of the plegmasia through its course will be more 
precipitate. The inflammatory symptoms continuing to in- 
crease, we soon discover in the place primitively afiected an 
augmentation of size and sensibility, accompanied by lanci- 
nating pains; a collection of pus may soon be detected by its 
fluctuations beneath the finger; the part soon becomes thinner 
and spontaneously ruptures to give exit to the purulent matter 
contained within. 

This spontaneous opening, of the abscess is usually internal, 
and occurs between the fifth and tenth days. 

It will be perceived that in such cases it would be injudicious 
to limit ourselves to the use of local remedies; the source of 
the disease must be attacked, either by extracting a diseased 
tooth communicating with the part, or by effecting an opening 
into the phlegmon at an early period. This will be necessary, 
as the enlargement of the phlegmon may otherwise impede 
respiration and deglutition. It is often difficult to operate upon 
these affections when they are located in the posterior part of 
the mouth, and in order to do so without injuring the adjacent 
parts, the instrument described in Plate XIV. Fig. 4, should 
be selected. The abscess being opened the operator should 
be particular to incline the head of his patient in such manner 
that the pus may escape from his mouth and not descend into 
the stomach. 

The opening of the abscess should be capacious, that it may 
not close prematurely, as a new collection of pus may other- 
wise be formed, and the retention of which may, by its com- 
municating with sockets of the teeth, destroy their periosteum 
and occasion an ulceration that would soon assume a fistulous 
character. 

Fistulous Ulcers of the Gums. — {Dental Flstules of J\Jg- 
derns.) — It often happens after the opening of abscesses of the 
gums that the succeeding ulcerations make no approach toward 
cure, although the most efficacious remedies be applied. We 

10* 



114 



maury's dental art. 



may in such cases infer the existence of undiscovered causes, 
as decay of a tooth or of the maxillary bone, or the presence 
of fractured particles of the alveolar processes. 

These ulcers (which M. Duval has made the subject of a 
memoir) have their seat at the base of the inferior jaw, and 
sometimes near the menial apophysis of the maxillary bone. 
Their borders are callous and tumefied, their circumference is 
red, smooth or mammillated, and in general, slightly oedema- 
tous. Sometimes this ulcer presents only one orifice, and 
which is nearly concealed by the presence of a serous ichor 
which has been discharged from it and become congealed in 
the atmosphere, At other times w^e observe two or three of 
these orifices very close to each other. If the ulcer is ex- 
posed to the air, the dried serous matter will form a crust 
behind which fresh serum will accumulate, and becoming puru- 
lent, will constantly increase if care be not taken to eva- 
cuate it. Cases in which suppuration and necrosis of the bone 
have taken place, will exhibit one or two openings communi- 
cating outwardly, which give passage to a fetid, bloody pus. 
By means of a probe we can then discover that the bone is 
denuded. The pus forms for itself an issue into the mouth. 
The tooth involved is now no longer sensible and becomes 
loose, and we may with the fingers or the sound, remove the 
sequestra, which, with the tooth, should be taken away if too 
much resistance be not ofiered. The fistulous openings will 
then cicatrize. 

The treatment of dental fistules is therefore limited to the 
extraction of the foreign substances, (including the diseased 
tooth,) which are the causes of them, and assisting the exfo- 
liation of the necrosed bone by such remedies as art has dis- 
covered. To prevent these affections the extraction of all de- 
cayed and painful teeth is the only certain means. To prevent 
the pus from issuing externally, and thus disfiguring the face 
a free incision should be made internally as soon as the afi'ec- 
tion manifests itself between the cheek and gum. 

Adhesion of the Gum to the Cheek. — This adhesion, which is 
usually accidental, though sometimes congenital, may be oc- 
casioned by ulceration of the gum or cheek, and by the 
immoderate use of mercury. Phlegmons and fistules of the 



DENTAL PATHOLOGY. 



115 



gums may occasion it. Adhesive inflammation of these parts 
may be partial or total, upon one or both sides. 

The functions of the mouth are interfered with by these ad- 
hesions to a greater or less extent in proportion to the extent 
of the affection. They may generally be prevented by the 
use of mucilaginous gargles, and by frequently passing between 
the cheek and gum a brush dipped in this liquid. The ad- 
hesion may be destroyed with the fingers, if recent, and the 
separation being thus effected, we should endeavour to keep 
the parts from each other, that a new adhesion may not be 
formed. 



SECTION II. 

SWELLING AND VARIOUS ULCERATIONS OF THE GUMS. 

Affections of the Crums in Scorbutus. 

The gums, alveoli, and maxillary bones undergo great change s 
in scorbutus. Without giving a description of the disease, 
which would be altogether foreign to our subject, we shall 
point out the various alterations of the parts, and also the 
means customarily employed to subdue them. 

In this disease the gums are generally first attacked. A 
troublesome itching is the earliest symptom; they soon tumefy, 
become red, and bleed on the slightest touch. Sometimes they 
will continue in this state; at other times the disease pro- 
gresses. The gums then become fungous, of a livid red, and 
emit a fetid odour; they soon become swollen and ulcerate. 
This ulceration in some cases involves the whole dental arch. 
Hemorrhages frequently occur, and the teeth, which become 
black or brown, loosen and often fall out. The disease some- 
times extends to the maxillary bones, upon which it produces 
extensive decay, and in this manner exposes the dental nerve, 
and thus occasions the most excruciating pains. Sometimes the 



116 



mauey's dental art. 



gums become so black that one would suppose them to be gan- 
grenous, if the odour, sui generis, indicated its presence. In 
scorbutic affections we often observe fungous excrescences 
which acquire a very large size. These excrescences are some- 
times of a livid red, and sometimes of a sandy gray colour. 
Their forms are various, and, when they are not rough, upon 
large bases or straight pedicles, they are ragged as if torn. 
Sometimes these tumours have a firm consistency; but gene- 
rally they are flabby and bloody. 

There are remedies appropriate to these affections. When 
the gums commence to tumefy, and become spongy, and the 
teeth are becoming loose, and there exists no ulceration, it 
will be proper to have recourse to gargles, acidulated with 
the sulphate of alumine and sulphuric acid, which will also be 
useful in arresting the passive hemorrhages. If the fungous 
excrescences be very hard or firm, it will be well to excise 
them. In cases of simple ulceration, gargles of barley-water, 
honey of roses, muriatic acid, or even oxycrate lotions, will be 
proper. This treatment is generally successful with children. 
If the dental nerve be exposed, we, should endeavour to fill the 
cavity of the tooth with cotton dipped in a tincture of opium. 
This means it will be necessary to adopt, as we cannot plug 
the tooth in this condition of the mouth, and the extraction of 
it might produce a hemorrhage difficult to check. 

Such are the various means used to effect a cure of scorbutic 
affections of the gums. The treatment, it will be observed, is 
purely local ; but entire success cannot be hoped for without 
resorting to general remedies, for which the physician must be 
applied to. 

Scurvy of the Gums. — This affection, as its name indicates, is 
peculiar to the gums, and resembles, to some extent, the dis- 
ease improperly called scurvy, which, at its commencement, is 
strictly local. Scurvy of the gums often incommodes but 
little the person affected, but, if neglected, may produce seri- 
ous consequences. It is manifested by softness, lividity and 
swelling of the gums, which bleed upon the slightest touch. 
This swelling at first appears between the teeth, and there 
forms small fungi, whose surfaces become easily excoriated. 



DENTAL PATHOLOGY. 



117 



Sometimes inflammation attends these, and produces ulcera- 
tion, which destroys a part of the gums, and thus denudes the 
roots of the teeth. Suppuration between the gums and alveoli 
is then brought on, and these parts are destroyed by means of 
a purulent, glutinous and fetid matter, which insinuates itself 
between the teeth and the wails of their alveoli. The teeth 
become loose, and, after a time, drop out. Sometimes the 
disease is confined to a part of the mouth ; at other times it 
extends its ravages over both jaws. When it is partial, it may 
occasion but slight inconvenience to the patient; and it has 
been known to continue in this condition for years, resisting 
every remedy applied to it. The suppuration may be caused 
by filthiness of the teeth, and swelling of the gums and fulness 
of their vessels. This disease is observed in men from thirty- 
six to forty years of age; in women whose catamenial dis- 
charges are irregular, or have ceased; in subjects of a lymphatic, 
melancholic, pituitary temperament; persons inhabiting humid, 
marshy, and unhealthy localities; and such as have endured the 
suppression of some periodical discharge, or the repercussion of 
cutaneous diseases. 

This morbid condition of the gums is cured by removing 
all foreign matter that may be found between the teeth, and by 
keeping the parts in a state of cleanliness. 

The gums are often painful, and so much engorged as to rise 
above their natural level. In this case, they should be slightly 
brushed once or twice a day, and an emollient or narcotic de- 
coction should be Used in order to cause them to bleed, and 
thus to disgorge themselves. This mode of treatment is pre- 
ferable to cutting, scarifying, or cauterizing them.* The 
general remedies capable of subduing scorbutic affections, pro- 
perly so called, should not be neglected. The mouth of the 

* Scarifying should not be condemned in these cases, as relief may often 
be the more speedily afforded by its means. It is recommended by Messrs. 
Hunter, Fox, and Bell. " The application of leeches," Dr. Harris remarks, 
"is also attended with the most decided advantage." " After the gums have 
begun to recover, amendment will be much accelerated, by washing the 
mouth with some tonic and astringent lotion." 

Dr. Fitch recommends as a wash for the mouth a decoction of the inner 
bark of green white oak, which Dr. Harris asserts, he has prescribed and 
always found beneficial. — S. 



118 



maury's dental art. 



patient should be kept strictly clean, and to accomplish this we 
should remove slime and all foreign substances that may have 
collected upon the gums, necks of the teeth and their inter- 
stices, and even in their decayed cavities. 

The scorbutic affection being destroyed, the patient should 
pay the strictest regard to cleanliness, and substitute for the 
emollients or narcotics, tonics or absorbents. 

Gangrene of the Gums. — This disease imperatively demands 
our attention. It has been cdWed putrefaction of the gums; and 
is met with in adults, but more frequently in children, espe- 
cially when collected in large numbers, as in hospitals, where 
the atmosphere is vicious, and the nourishment given of a bad 
quality. This singular affection is unseemly in its character 
and formidable in its effects. It progresses with frightful 
rapidity, and the loss of teeth occasioned by it is but a small 
part of the evil consequences attendant upon it. The children 
attacked by it have ordinarily swollen countenances and fulness 
of habit; the gums become tender, assume a purple colour, are 
painful and turgid, and the breath emits an odour highly fetid, 
offensive, and very warm; a species of gangrene supervenes, 
which is almost always fatal in very young subjects. 

Strict cleanliness of the mouth, and hygienic remedies, aided 
by appropriate general treatment, will suffice to subdue this 
disease, the alarming symptoms of which we have often dis- 
persed by recommending succulent and animal nourishment, 
wines, and the avoidance of all exposure to a moist and un- 
wholesome atmosphere. 

Affections of the Gums in Scrofula. — The gums in scrofulous 
subjects are generally pale and soft; but are sometimes tume- 
fied, turgid and ulcerated. This morbid affection evidently 
arises from constitutional tendency. The appropriate treat- 
ment consists in the employment of internal remedies, which 
may be assisted by the use of such lotions as decoctions of 
bark, &c., frictions upon the diseased parts, with a small quan- 
tity of quinine and magnesia. 

Affections of the Gums occasioned by Syphilitic Virus. — Upon 
the mucous membrane of the mouth this virus produces ulcers 



DENTAL PATHOLOGY. 



119 



of a peculiar character, bearing no resemblance to other affections 
of these parts. Their treatment must necessarily coincide 
with that usual in syphilitic affections, but of which it is not 
our purpose to treat. 

Affections of the Gums caused by the use of Mercury. — These 
affections may be produced by the internal or external use of 
mercury. They present varied excoriations, which, on account 
of their cause, have been called mercurial excoriations. Per- 
sons who use this mineral as a medicine, and miners and others 
engaged in procuring and preparing it, are always exposed to 
these effects. 

At the period of the formation of this affection, heat is expe- 
rienced in the gums; these become engorged; small tubercles 
make their appearance, which imposthumate and leave ulcers, 
whose depth and extent are increased in proportion as the 
process of cicatrization is deferred. These ulcerations are 
generally more numerous than those produced by syphilitic 
virus. Their forms are various, their bottoms are gray, and 
sometimes bloody. 

In cases in which the quantity of mercury absorbed is very 
large, the engorgement of the gums is excessive, the ulcera- 
tions are numerous, and not confined to the gums, but occupy 
the sides of the tongue and whole extent of the buccal mem- 
brane. The ptyalism is in proportion to the irritation, and 
the mouth of the patient emits an offensive odour. The pre- 
cautions now taken in the administration of this medicine for- 
tunately render these evils very uncommon. 

When mercury has produced upon the gums or other parts 
of the mucous membrane which lines the mouth this descrip- 
tion of ulceration, we should immediately suspend the use of 
it, and prescribe soothing gargles, or a mucilaginous decoction 
containing a few drops of laudanum. If the salivation be very 
abundant, we should endeavour to check it by the use of cold 
applications to the jaws, purgatives, and pediluvia. 

Should the gums, after these various affections, remain soft, 
tumefied and turgid, it would be well to use the alcoholic tinc- 
ture of rhatania, spirit of scurvy grass, or any other aromatic 
tincture. 



130 



SECTION III. 

FUNGUS OF THE GUMS. 

Fungous Tumours, or Epules, — These tumours, or fleshy- 
excrescences, generally soft and fungous, but sometimes hard 
and cartilaginous, make their appearance upon the gums, or 
gradually arise from the sockets of decayed teeth. At times 
they are developed spontaneously, without any visible cause ; 
but at other times the cause is palpable. In the latter case, 
they are the result of an abscess of the gums, which we have 
named parulis, or they are dependent upon ulceration of the 
gums, or decay of one or more teeth, (PI. XIII. Fig. 8,) parti- 
cularly when the roots are diseased. They may, sometimes, 
be attributed to caries or necrosis of the alveoli, and even the 
maxilla itself. 

Five varieties of this disease are described, owing their clas- 
sification to the several causes from which they spring. Firsts 
simple epulis, unaccompanied by ulceration of the gums; 
second, cartilaginous epulis ; third, epulis proceeding from 
parulis, occasioned by decay of one or more teeth ; fourth, 
epulis accompanied by decay of the maxilla; fifth, epulis pro- 
duced by necrosis of the maxilla.* 

* " Tumours and excrescences of these parts are very variable in their cha- 
racter and appearance. The surface of some is smooth; that of others is 
rough, and sometimes covered with eroding ulcers : some are bulbous, and 
have a broad base; others are attached to the gums by a mere peduncle: 
gome are soft, others are hard; the growth of some is astonishingly rapid j 
that of others is so slow as to be scarcely perceptible : some are almost 
destitute, of blood vessels ; others appear to be almost wholly composed 
sanguiferous capillaries : some are nearly destitute of sensibility ; others are 
so exquisitely sensitive that the slightest touch produces great pain, whence 
they have been named noli me tangere : some are nearly white, others have 
a grayish appearance : some retain the colour of the natural gum ; others are 
of a dark purple hue : finally, some exist for years, without being attended 
with any very serious consequences, while others, in a very short time, bring 
on a general constitutional derangement." — Harris' Dental Art, p. 251.) — S. 



DENTAL PATHOLOGY. 



121 



Epulis generally appears under the form of a small tuberclcj 
of a pale red, and having inequalities upon its surface. This 
tubercle is covered by a thin, smooth membrane, and has a 
pedicle more or less developed : it is slightly painful, gradually 
grows, and, after a time, assumes a volume of greater or less 
magnitude. The tumour may become sufficiently large to 
loosen the teeth, and incline them toward the cheek or tongue, 
in such manner as to produce pain. Tumours of this kind are, 
in general, soft throughout their whole course; but, at times, 
the opposite condition characterizes them. They have in them 
several perforations, from which is continually discharged a 
viscous' bloody humour. 

Their implantation upon -the gums is not always the same. 
Sometimes they grow upon a simple pedicle, at other times 
upon a large base. In the former case they will grow without 
involving the gums, and hence their removal is not difficult; 
in the latter case they insinuate themselves between the inter- 
stices of the teeth, and occupy the opposite side of the alveolar 
border, in which case their removal is difficult. 

From what v<7e have said, these tumours will not be con- 
founded with swelling of the gums, produced by a scorbutic 
diathesis or the use of mercury; for in these affections it is 
not a tumour which forms and grows upon the gums in the 
neighbourhood of diseased teeth, but it is tumefaction of the 
whole of the gums, which also become spongy and turgid. 
Nor should they be confounded with sarcoma of the maxilla, 
nor with phlegmons of the gums, the symptoms of which are 
altogether different from those that accompany epulis. Abscess 
of the gums is always accompanied by heat, redness and con- 
siderable swelling of the cheek; its progress is generally rapid, 
but it yields to antiphlogistics. The excrescences of which we 
are now speaking develope themselves slowly, are not accom- 
panied by inflammatory symptoms, and do not 3neld to ordi- 
nary remedies. The characteristics we have described are pal- 
pable and distinct, and there can be no doubting the identity 
of these several affections. 

Epules are not in general serious maladies, and may be easily 
cured, when not prolonged by some continued cause, and when 
pediculated. When caries or necrosis of the maxilla is the 
11 



122 



maitry's dental art. 



cause, they will not yield until the affection of the bone has 
been cured. Their treatment will naturally be deduced from 
the causes from which they originated. The ligature, the 
knife, and actual cautery, are the means to be resorted to. 

In case of simple epules, or cartilaginous epules upon a pe- 
dicle, the ligature or knife should be applied to the base of 
the pedicle. When hemorrhage succeeds this operation, it 
should be arrested with the actual cautery, which will also serve 
to destroy such portions of the tumour as may remain, and to 
repress it should it exhibit a tendency to be reproduced.* 

If epulis be accompanied by caries of one or more of the 
teeth, the extraction of such tooth or teeth will serve to re- 
move the cause of the tumour and to expose its pedicle. The 
knife should then be resorted to. After having with a bistoury 
extirpated as much as possible of the tumour, we should, as 
before directed, have recourse to the actual cautery. If the 
tumour be occasioned by caries of the maxilla, we should, 
having excised the former, change the caries into necrosis, also, 
by means of the actual cautery, and await the exfoliation of 
the necrosed parts. If the epulis be produced by necrosis, we 
should remove or destroy the fungous flesh, and wait until ex- 
foliation takes place ; a cure may then be effected. 

Astringent powders and detersive gargles are the auxiliary 
means that should be applied during the wliole course of the 
disease in the treatment of every variety of epules. 

We here terminate our remarks upon the diseases of the 
dental organs proper, and some of the affections of the adjacent 
parts; and we shall now pass on to the second part of our 
work, in which we propose to examine the various general 
means employed for the preservation of the teeth, and the 
operations that appertain especially to the dental art. 

* These tumours should always be removed by means of the ligature when 
possible, inasmuch as the hemorrhage succeeding excision should be dreaded. 
Arteries going to increased parts," Mr. Hunter remarks, "are themselves 
increased, and have not the contractile power of a sound artery." If the 
base of the tumour be broad, the mode that has been recommended of passing 
a needle through its whole breadth and carrying the ligature thence around 
either side, is advisable. — S. 



PART II. 

DENTAL HYGIENE AND THERAPEUTICS. 



PART 11. 



DENTAL HYGIENE AND THERAPEUTICS. 

GENERAL MEANS OF PRESERVING THE TEETH AND OTHER 
PARTS OF THE MOUTH AT ALL PERIODS OF LIFE. 

The health and beauty of the teeth, and the wholesome 
condition of the adjacent parts, may be impaired by so many 
causes, that the means of protecting them from morbid affec- 
tions have ever been objects of diligent research. These means 
are generally simple, and are supplied by hygiene, and are 
subject to general principles, which we shall indicate. 

The teeth of first dentition require no particular attention, 
at least when not affected by caries. When thus affected we 
would recommend them to be brushed frequently to prevent 
the progress of this disease. It is not until the age of seven 
or eight years that the child should be required to brush his 
teeth, and simply a brush and water should then be used. 
This precaution will not only prevent caries, but will retard its 
progress, and prevent the pain that may result from it. The 
mouth will thus also be retained in a state of cleanliness and 
agreeable freshness. We may also, without injury, detach, by 
means of suitable instruments, the tartar that collects upon the 
teeth of children at all ages.* 

* The advice here given may lead to error, for it certainly is not in all 
cases applicable. Indeed, we are of opinion that throughout the vf hole period 
of life strict regard to cleanliness of the mouth should be had, and betvireen 
infancy and age there should be no distinction made except as relates to the 
means used. Thus, although a brush, or any thing that could irritate the 
gums of infants, should be avoided, the finger of the nurse may serve a good 
purpose in keeping these parts free from accumulations of any substance, 
and also in giving tone to them by the gentle friction thus applied. 



126 



maury's dental art. 



From the age of fifteen to that of twenty years, we may^ 
according to the condition of the mouth, employ powdered or 
liquid dentifrices. Persons upon whose teeth tartar easily 
accumulates, may add to the water applied a little brandy, or 
other spirituous liquors. The brush should be dipped into 
such liquid, the teeth and gums should be well rubbed with 
it, and it should be made, if possible, to penetrate the decayed 
cavities. A powdered dentifrice should also be applied three or 
four times a week, and should be rendered more or less tonic 
and active in its mechanical effects, according to the condition 
of the mouth and teeth. ,^ ' 

At all ages the teeth should be well attended to, and experi- 
ence proves that daily cleansing is their best preservative. It 
is proper to clean them after every meal, to remove particles 
of aliment that may adhere; if there be lodgments for such 
between the teeth, a toothpick will be proper. We should also 
endeavour to prevent the accumulation of a slimy substance, the 
layers of which, at first superficial, tend constantly to increase 
in thickness. The daily use of the brush will, however, suffice 
to prevent this. If the molar teeth of both sides be used con- 
stantly, the friction will in general prevent the accumulation of 
tartar, but still the habit of rinsing the mouth after eating 
should not be disregarded. We would here remark that a 
piece of linen, used by some persons in cleaning the teeth, is 
not adapted to the purpose, as thus the prominent parts only, 
which least require rubbing, are cleaned, while instead of 
cleansing the interstices the food is thus pressed more com- 
pactly into them. 

The preceding advice is designed especially for delicate per- 
sons, and also for those who have good and handsome teeth, 
but are guilty of neglecting them. Persons who wear artificial 
teeth should be still more careful, especially, if they be manu- 
factured from animal substances; otherwise such teeth will 
become covered with tartar and decompose, and be productive 
of an insupportable fetor. 

Means of preserving the Gums. — Independent of the ordinary 
means of preserving the teeth in cleanliness, there are applica- 
tions that become proper whenever the gums are not in per- 
fectly good condition, and the importance of which we pointed 



HYGIENE AND THERAPEUTICS. 



127 



out while speaking especially of the diseases of these organs. 
When the gums are soft, pale or turgid, the water used should 
be stimulated with spirituous liquors slightly aromatised; fric- 
tions applied with a soft brush will impart tons if the debility 
be merely local. If their sponginess, on the contrary, be pro- 
duced by constitutional impairment, we should have recourse 
to constitutional treatment. Tonics are here indicated to give 
energy to the whole system. 

Dentifrices, Powders, Opiates, Liquids, Elixirs, SfC. — Although 
brushing the teeth, with the use of a few drops of spirits in 
water, will usually suffice to preserve them in cleanliness, 
there are persons who, from constitutional causes, or from pre- 
vious neglect, are required to employ more energetic means. 
Hence many substances have been proposed for this purpose. 
These are called dentifrices, and are usually composed of se- 
veral medicinal substances reduced to a fine powder. Among 
these powders some are innocent, such as charcoal, iris, soot, 
bark, salt. There are others, which are injurious to the teeth, 
such as acids. Others, again, are excellent agents in rendering 
the mouth clean and pleasant. These three classes of denti- 
frices we shall briefly review. 

Charcoal holds the first place in our series of powders. Al- 
though this substance, finely pulverized, has been for a long 
time a popular dentifrice, because of its preservative qualities, 
its use is now almost entirely abandoned ; the objections to it, 
however, do not result from any injurious efiects to the enamel 
of the teeth, but from its insinuating itself between the necks 
of the teeth and the gums, it blackens them, and gives to them 
a gangrenous appearance. It may, however, be removed from 
this lodging by frequent washing and rubbing with a soft brush. 
Burnt crusts of bread, and all substances reduced to carbon, do 
not differ materially from each other. 

Soot. The use of this article as a dentifrice has been long 
practised, and has been upheld by many w^ho proved its excel- 
lence by the fact, that the teeth of chimney sweeps are always 
white. But this fact is not true. The teeth of these individu- 
als appear so, contrasted with their skin. This substance, like 
the preceding, is troublesome and unpleasant, and it may readily 
be replaced by vegetable powders. 



1S8 maury's dental art. 

Bark, reduced to a fine powder, like other vegetable sub- 
stances, can in no manner injure the enamel of the teeth, and 
on this account should hold a place in our first class of denti- 
frices; but its taste and colour, its tanning principle, which make 
the enamel yellow, and the fact that it contains no known use- 
ful property, all indicate its unfitness for this purpose. Pow- 
dered bark is, however, very beneficial in strengthening the 
gums when soft and spongy. What we have said of bark is 
equally applicable to tobacco. 

Salt. {Muriate of Soda.) This article, recommended by 
many, is not at all injurious. It soon dissolves in the mouth, 
and can produce no other efiect than that of causing an abun- 
dant flow of saliva, but by no means serves the purposes in- 
tended to be efiected. 

Alum.^Alum, Cream of Tartar, and Oxalic Add, we place in 
our second series of powders. The former of these is a very 
strong stiptic, and should only be used in combination with an 
absorbent substance capable of destroying its acidity. Our 
third series furnishes an example of this, and among the pow- 
dered dentifrices which appear to belong to this class, we give 
the following formula. 



DETERSIVE POWDER. 

Magnesia, ) 

rrr L J- each one pound. 

Cream of Tartar, ) ^ 

Sulphate of Quinine, five drachms. 

Cochineal, one ounce and a half. 

Essential Oil of Peppermint, four drachms. 

Essential Oil of Cinnamon, three drachms. 

Essential Oil of Orange Flowers,. ..two drachms. 

Spirits of Amber, Muskrose, one drachm. 

Reduce each of these substances separately to a fine powder ; grind the 
cream of tartar with the cochineal to colour it ; place the essences with the 
magnesia in a vase, and when absorbed, mix with the first powder and pass 
the whole through a fine sieve. 

This powder will clean the teeth perfectly without affecting 
the enamel; it strengthens the gums, gives them a rosy hue, 
and agreeably refreshens the mouth. The brush should not be 
very wet on being dipped into this powder, as some of its in- 
gredients are soluble. It should be kept in a dry place. 

We may rub the teeth with this two or three times a week, 



HYGIENE AND THERAPEUTICS. 



129 



and even daily, without inconvenience. For young people, 
from twelve to eighteen years of age, once a week will be often 
enough. 

We here give the manner of preparing with charcoal and 
bark a detersive and tonic powder. 



Carbon of white wood, § viij. 

Bark, 1 iv. 

White Ginger, § viij. 

Essential Oil of mint, 3 i^- 

Essential Oil of Cinnamon, 3 ij. 

Spirit of Amber, Muskrose, 3 



Reduce to impalpable powder and mix. 

An excellent dentifrice may be made of three or four hard 
substances selected with judgment. There is nothing that 
evinces so much charlatanism as the heterogeneous mixture of 
various powders, and to which an imposing name is given. 
Powders prepared according to the formula of an intelligent 
dentist, offer always a surer guarantee than those of the per- 
fumers and others, who do not give the subject the requisite 
attention. 

Acidulated dentifrices are only capable of imparting to the 
teeth a flattering whiteness; but we cannot be too circumspect 
in resorting to the use of them. They but produce upon the 
teeth the same effect that a drop of acid does upon polished 
marble. The calcareous phosphate composing the enamel is 
dissolved, and its polish is destroyed. The teeth in conse- 
quence retain more easily than before the species of slime which 
continually tend to accumulate upon them, and assume an in- 
delible yellovv hue. If such dentifrices be long continued, and 
if the acids which enter into their composition be very concen- 
trated, it will expose the gelatinous substance of the teeth, 
which then become sensible to the slightest impressions, and 
finally decay. 

Opiates and Mixtures. 

The first quality of a dentifrice should be to render the teeth 
perfectly clean without injuring them. It should also be agree- 
able to the sight, the smell and the taste, and even tend to im- 
part to the gums a rosy tinge to contrast with the whiteness of 
the teeth. A small quantity of cochineal, carmine, lack, &c. 
are usually added to powders and opiates for this purpose. 



130 



maury's dental art. 



Opiates and Mixtures differ from powders by being composed 
in part of sirup or honey. These preparations are by some 
persons preferred to powders. There is, however, no good 
reason for this preference. 

The following is the formula and mode of preparing a mix- 
ture which we recommend. 



Honey of the best quality, ib ij. 

Alum calcined, ^ ij. 

Bark, extract of, g j. 

Essential Oil of Peppermint, ) ^^^j^- ^^^^ 

Essential Oil of Cinnamon, 5 

Spirit of Amber, Muskrose, ^ ij. 



Reduce the honey one-third, colour it with a piece of orchanet; mix the 
extract of bark into this, and strain it through a fine linen cloth. When it 
is nearly cold, incorporate into it the alum, and when quite cold add the 
essences. 

This preparation has the same properties as the detersive powder, and 
may be used in like manner. 

Liquors, Elixirs, and Tinctures , for the Mouth. 
These various preparations are so many dentifrices used by 
dentists to maintain the cleanliness of the mouth, to relieve 
pains of the teeth, and to give tone to the gums. They should 
all have alcohol for their base; they are simple or compound, 
and are used instead of powders when the teeth have carious 
cavities, which are inaccessible to the brush, and when the gums 
are excessively sensitive. As those preparations are in gene- 
ral highly concentrated, a few drops should be put in a proper 
quantity of water, and the teeth and gums brushed with it. 
They are usually coloured with orchanet, cochineal, white moss, 
gum lack, saffron, &c., and aromatised with various essential 
oils. The following is a formula of one of these liquids, and 
may always be used with advantage. 

PHILODONTIC AND ANTI-SPASMODIC LIQUID. 



Alcohol, 38° O iv. 

Essential Oil of Mint, g j. 

Essence of Orange Flower, 5 iv. 

Essence of Cinnamon, 5 ij. 

Spirit of Amber, Muskrose, c g jss. 

Sulphuric Ether ,^ ss. 



After having coloured this liquor, filter it, and when put into a flask add 
the ether. 



HYGIENE AND THERAPEUTICS. 



131 



Persons who pay particular attention to the cleanliness of 
their teeth are very fond of using this preparation, as it leaves 
an agreeable perfume in the mouth. Eight or ten drops of 
this should be put into a tumbler of water, and the teeth and 
gums should be well rubbed with it by means of a suitable 
brush. It corrects the bad odour of the mouth, re-establishes 
and maintains the firmness of the gums, prevents caries of the 
teeth, and if properly used will arrest the progress of that 
disease. 

Tiiis liquid will also be of advantage in subduing certain 
nervous affections, hemicrania, vomiting, indigestion, and in 
imparting tone to the stomach. For any of these purposes a 
tea-spoonful should be taken- in half a tumbler of sweetened 
water; or a few drops of it may be put upon a lump of sugar; 
and retained in the mouth until the latter dissolves. 



TONIC ELIXIR. 

Root of Rhalania, o "^"J* 

Spirituous Vulneraria Water, O -yiij. 

Essentia] Oil of Mint, 5 ij. 

Essential Oil of Orange Peel, g^iij. 

Bruise the rhatania root, steep it for about eight days in the vulneraria wa- 
ter, filter, and add the essences previously mixed with four ounces of alcohol. 

This elixir possesses the property of curing several diseases 
of the mouth, as scorbutus in its incipient stage, aphthae, swell- 
ing of the gums, w^hich it also prevents bleeding. Fifteen or 
twenty drops should be put in the third of a tumbler of water, 
and retained in the mouth for a short time, and with a brush 
the teeth and gums should be well rubbed. If this lotion be 
used twice or thrice a day the ulcers will soon disgorge them- 
selves and cicatrize, the swelling and discharge from the gums 
will cease, the bad odour from the mouth will be corrected and 
the teeth that may be slightly loosened will become firm again. 

The inhabitants of the island of Molucca, and those of the 
southern parts of China, differing from us in their ideas of 
beauty in the dental organs, do not endeavour to preserve them 
in their whiteness, but tinge tbem a brick red with a prepara- 
tion which they continually chew, and which is called betel, 
although the leaves of this vegetable do not form its principal 
ingredient. The natives of regions near the equator use this 



132 



maurt's dental art. 



substance in a different manner. They spread slacked lime 
upon a betel leaf, and after having enveloped the fourth part of 
an areca nut with this, they roll it into a compact ball, and con- 
stantly retain it in the mouth. During their visits these people 
chew this substance; in saluting each other it is always present- 
ed in courtesy; and in taking leave on departure it is always 
presented enclosed in a little silk bag; they do not presume to 
speak to persons of rank without having it in their mouths. 
Betel does not corrode the dental substance, as many have sup- 
posed; it merely deposites upon the teeth a species of tartar 
which gives to them a red colour. We have been able to 
convince ourselves of this fact by carefully examining the teeth 
of a sailor whom we met at Gravesend in England. We also 
had occasion to make a similar examination upon the head of a 
Chinese, aged about thirty-six, which was presented to us by 
Dr. Busseuil of the Royal Navy. The teeth of this head, inde- 
pendent of their red colour, were also covered with a layer of 
tartar, at least one-fourth of a line in thickness. We detached 
some fragments of the tartar, and none of the teeth submitted 
to our research presented any traces of decay. The person 
above -alluded to also had sound teeth. These two facts, with 
others we might add, appear to us more than sufficient to refute 
the following passage in the Dictionary of Medical Science, 
vol. 11. p. 38: — "The betel, (piper-betel) is so irritating that it 
corrodes the dental substance, and persons in the habit of 
chewing it are deprived, at from twenty-five to thirty-five 
years of age, of the crowns of all their teeth; but this conse- 
quence does not prevent its general use throughout all the isles 
of the Indian Sea.'' 

The inhabitants of the Philippines, instead of staining their 
teeth with the betel, continually rub them with the thin and 
smooth rind of the areca nut (areca catliecu.) This manner of 
cleaning the teeth has here become a habit. 

The piece of skin destined for this use is usually from an 
inch and a half to two inches long. The common people use 
the rind as taken from the nut, but the wealthier bind a piece 
of ornamented silk around it. 

It would have been easy for us in treating of dentifrices to 
multiply formulae; but knowing that such enumeration would 



HYGIENE AND THERAPEUTICS. 



133 



be of no advantage to the reader, we have preferred to merely 
give such as are of known efficacy. Tinctures, as elixirs, 
may be simple or compound, and may be extemporaneously 
composed. It is in this manner by macerating bark, myrrh, 
&c. in brandy, we obtain an excellent tincture for the teeth 
and gums. 

Nothing need be added to what we have already said on 
the subject of dentifrices; but as their employment is of the 
highest importance, too much attention cannot be given to 
their selection and preparation. We therefore would in con* 
elusion remark, as a summary of what we have said. 

First, whatever may be the mode of preparing medicinal 
dentifrices, we should use no substance that is capable of de- 
composing the enamel, since the use of dentifrices should be 
to preserve the natural colour of the teeth by removing tartar 
that may have collected upon them. 

Secondly, we should carefully watch their action upon the 
gums. 

Thirdly, they should vary in form and composition to suit 
the parts to which they may be applied. 

INSTRUMENTS AND MATERIALS USED FOR CLEANING THE 
TEETH. 

Brushes. — In form and consistency these must vary accord- 
ing to circumstances. Thus small ones are proper for very 
young, and larger ones for grown persons, and a softer brush is 
proper for persons whose gums are peculiarly sensitive than for 
others. Judgment in each case is therefore necessary. But 
care should be taken to adapt them well, as thorough cleansing 
of the teeth and proper friction upon the gums are important; 
nor should the grinding surfaces and internal sides be less 
carefully attended to than their anterior surfaces. In brushing 
the molar teeth a slight rotary motion of the brush will prove 
serviceable in^dislodging substances deposited between them. 

Sponge or Cotton, attached to a handle or otherwise, has been 
unwisely recommended for these purposes. The same objec- 

12 



134 



maury's dental art. 



tions exist to them that we urged against the use of linen, 
namely, that it cleanses only the acclivities of the teeth, while 
it presses particles of food or other substances more compactly 
into the interstices. Brushes made of the hair of the she-goat 
and badger have been made use of, but they are inferior to 
those made of the common bristles. Their use, however, may 
be admitted when the teeth and gums are very sensitive. 

Tooth-picks — These are usually made of horn, quills, shells, 
fibres of flexible wood, ivory, bone, gold, silver and steel. 
Their name indicates their use, but they are only proper to 
remove foreign bodies that have insinuated themselves between 
the teeth, and which cannot be dislodged by the tongue or 
brush. The teeth, and especially the gums, should be tor- 
mented as little as possible with these and similar instruments. 

The best tooth-picks are those made of young goose quills, 
shells, flexible wood, &c. 

Roots. — Sometimes the fibrous root of licorice, lucerne, the 
common rose, and marsh-mallow, are used for cleansing the 
teeth. They are cut into pieces of four or five inches in length 
and boiled: when dried they are beaten into a kind of brush. 
They are then coloured red with a decoction of cochineal while 
heated, and perfumed with alcohol containing aromatic oil. 
These roots are, however, rarely used, and can in no respect 
be compared with the tooth-brush. 

Coral Sticks. — Small sticks, composed of various calcareous 
powders, coloured red, and rendered partially soluble by the 
addition of a sufficient quantity of gum Arabic, have also been 
used for cleaning the teeth. They are about the size of a crow- 
quill. Their use has been abandoned, because they exercise 
too much friction upon the teeth, which, at the same time, 
they do not thoroughly clean, and they also chafe the gums. 

GENERAL RULES FOR THE PRESERVATION OP THE TEETH. 

Independent of the hygienic means that the gums and teeth 
require, there are also other precautions necessary for the 



HYGIENE AND THERAPEUTICS. 



135 



beauty and health of these organs: these consist in avoiding 
whatever may be injurious to them. These indications may 
easily be fulfilled. 

First, by refraining from washing the head in cold lotions; 
avoiding the use of repercussives, sometimes applied to de- 
stroy blotches of the face; also, pomatums, used to dye the 
hair, which are mostly composed of metallic, astringent and 
caustic substances. 

Secondly, by avoiding the cracking of hard bodies with the 
teeth, or in any manner straining them by pressure, especially 
if they be long and weak. 

Thirdly, by refraining from using the teeth to cut threads, 
&c. as women and children are in the practice of doing. By 
this habit the teeth are often fractured, and are hence subject 
to decay. 

Fourthly, by not allowing particles of food or other sub- 
stances to remain in the cavities of the teeth; by guarding 
against the use of improper dentifricesj such as coral, pumice 
stone, or waters, liquors, elixirs and tinetures too highly aci- 
dulated. 

Fifthly, by protecting the teeth from sudden transitions of 
heat and cold, as in the alternate use of hot and cold drinks ot 
aliment. After smoking, a current of air should be shunned. 
As it is not smoking that injures the teeth, but by the contact 
of cold air upon them, after being thus warmed, inflammation 
of their pulps is produced, which may result in caries, parti- 
cularly in teeth, which, by their structure and position, have 
already a tendency to this disease. 

Sixthly, by avoiding exposure to low and humid places. 
We have remarked that persons who reside in localities where 
the temperature changes frequently, have commonly indiffer- 
ent teeth. 

Seventhly, by refraining from drinking mineral waters in 
greater quantities than may be necessary; as their daily use, 
when special care is not taken with the teeth, will set these on 
edge, render them painful, and make them j-ellow, or cover 
them with a black slime; also, by abstaining from the free use 
of sweet-meats, and exposure to the effects of mercury, and 
other metallic substances, which, being reduced to vapour, may 
decay the teeth in a very remarkable manner. If we cannot 



136 



maury's dental art. 



wholly abstain from exposure to all or any of those deleterious 
causes, we may to an extent prevent decay of the teeth by 
brushing them two or three times a day with water. 

These aphorisms might be extended, and much might be said 
of many habits that oppose the preservation of the dental or- 
gans; but such considerations would occupy too much space. 
We would therefore recommend to the reader, the more ample 
remarks upon this subject contained in works especially de- 
voted to it. 



THE various operations APPERTAINING ESPECIALLY TO THE 
DENTAL ART, AND THE DIFFERENT INSTRUMENTS PROPER 
IN THEIR PERFORMANCE. 

Among the operations that appertain especially to the dental 
art, some are intended to facilitate the eruption and regular 
arrangement of the teeth; others consist in freeing those organs 
from all injurious influences, and remedying the various influ- 
ences of which they are the seat, and which may occasion their 
destruction. We have already, in treating of the means by 
which we may remedy the evils of first dentition, indicated 
the procedures of this first class of operations; we shall now 
enter into the details that this important subject requires, after 
which we shall treat of operations of the second series. In 
our examination we shall endeavour to be as concise as pos- 
sible. 

Operations relating to the Teeth, and designed to facilitate their 

Eruption. 

It has long been thought that the difficulty encountered by 
the teeth of first dentition, in rising from the alveoli, depended 
upon the resistance ofiered by the gums. Under this impres- 
sion, after having tried various means to soften them, recourse 
w^as necessarily had to section of these parts, to give free issue 
to one or more of these teeth. This operation, seldom prac- 
tised, because of the capability of nature to efiect the desired 
object, consists in an incision made upon the gums with an 
instrument designed for this use. This incision should, in^ 



HYGIENE AND THERAPEUTICS. 



137 



general, be deep, if we would hope for success. The evils that 
may result from this operation may be subdued by emollient 
lotions. 

Manner of directing second Dentition. 

Although the deciduous teeth usually assume a good direc- 
tion, and arrange themselves properly upon the dental arch, as 
they are developed, this does not always happen with the per- 
manent teeth, which tend to assume a defective position, 
either on account of the contracted space in the alveolar arch, 
or on account of its conformation. The permanent incisores 
and cuspidati are much larger than the teeth that precede them, 
and have, at their eruption, attained nearly their full size. It is 
thought by many that permanent teeth have attained their full 
size at the time of the protrusion of their crowns through the 
alveoli. This opinion I deem incorrect, and to demonstrate 
this we have drawn (PI. XIII. Fig. 10,) two large inferior 
molares taken from the mouth of a child thirteen years old, 
one of which was extracted a year previous to the other. A 
comparison of these teeth exhibits a material difference in 
their size.* It is well known that at the period these teeth 
appear, the jaws have not attained their full size, especially 
near the alveolar border, which is at this time very narrow. 
It will, therefore, be perceived that the second teeth do not 
occupy precisely the same places that the deciduous teeth 
had, but often stand a little to one side of the place the deci- 
duous occupied, in such manner that though the latter do not 
prevent the permanentes from appearing through the gums, 
they may cause them to take a mal-direction. The permanent 
teeth being larger than the deciduous, are necessarily more 
crowded, and arrange themselves with more difficulty. 

* The opinion is entertained by some that the enamel is deposited by the 
membrane which invests it previous to eruption. Would not, therefore, the 
enlargement of the tooth after this necessarily destroy this covering? 

The cases furnished by our author, though entitled to consideration, cannot 
be regarded as warranting the conclusions we are desired to infer. There is 
much danger of error in placing too much confidence in such. The disparity 
in size may have existed at the period at which the firstof these teeth was re- 
moved; or, as frequently happens, the one may have been extracted previous 
to the complete eruption of the other. — S. 

12* 



138 



maury's dental art. 



The first measure to be adopted at the time of the eruption 
of the permanent teeth, is the removal of the deciduous ones. 
These teeth may be easily extracted; the fingers alone will 
often suffice to perform the operation, but forceps, adapted to 
the purpose, may with propriety be applied. We should not 
hesitate to extract such deciduous teeth whenever they may 
occasion the mal-arrangement of the permanentes. Irregulari- 
ties that may result from the presence of the deciduous teeth^ 
are always more difficult to correct than to prevent. But we 
should not be too precipitate in removing the deciduous teeth; 
first, because in their absence the jaws may contract, espe- 
cially if the teeth of replacement be long in coming forward; 
and, secondly, because these teeth have, in some rare instances, 
been known to endure permanently. In these cases, however, 
the teeth of first dentition retain their roots entire. These 
teeth sometimes remain until old age. The deciduous teeth 
are sometimes placed posterior, and sometimes anterior to the 
permanentes, and at other times they range with them. 

It often happens that the permanent teeth are developed 
more rapidly than the maxilla. The teeth, then, not finding 
sufficient space, present their lateral sides anteriorly, or are 
forced within or without the dental arch. (PI. XI. Figs. 1, 2, 7.) 
In such cases the dentist should act with circumspection, and 
on observing the maxillary bones to increase without facili- 
tating the regular arrangement of the permanent teeth, he should 
endeavour to correct their mal-position. Teeth, irregularly 
arranged, are always unseemly to the view, do not admit of 
being properly cleaned, and are more disposed to decay on this 
account. 

The best mode of correcting slight irregularities, is to extract 
one or two to preserve the rest. In this manner, which may 
at first appear harsh, the teeth being rendered less crowded 
will be less liable to decay, and having thus plenty of room, 
will naturally assume a regular arrangement. We may hasten 
the approximation of the irregular teeth, if necessary, by pass- 
ing silken ligatures around such of the teeth as should be 
inclined toward each other. (PI. XI. Figs. 1, 2, 7.) 

As it is in general the anterior teeth that are badly arranged, 
it might be supposed that one of these should be extracted; 



HYGIENE AND THERAPEUTICS. 



139 



but the approach of these toward each other would not autho- 
rize such procedure for the sake of symmetry. In such cases, 
according to the example of Garriot, the best practiciens ex- 
tract one, two, three, or four bicuspides, according to the space 
required in the anterior arch. We may also extract the cuspidati 
to effect a handsome arrangement of the teeth, as it is known 
that these teeth are often irregular. It is, however, not com- 
mon for us to have recourse to this; first, because their pre- 
sence is more essential to the symmetry of the mouth than that 
of the bicuspides; and, secondly, because, having stronger 
roots than the bicuspides, they serve as supporters of the ante- 
rior teeth. 

If, on the contrary, we extract a bicuspid, there will still 
remain one of the same class, and thus the mouth will not be 
disfigured; its situation in the middle of each side also permits 
the teeth to separate from each other with greater facility. 

These procedures are always easy, only requiring judgment 
and skill on the part of the dentist. 

Mode of correcting Irregularities, 

The mal-arrangement of the teeth arises from their inclina- 
tion inwardly, outwardly, or laterally, or from disorder occa- 
sioned by their transposition. We should endeavour to remedy 
these irregularities by all possible means. Success in such 
cases will depend entirely upon the intelligence and ingenuity 
of the practicien. 

In general the means should act slowly, and be continued, 
without occasioning pain; and, as the teeth that have taken a 
bad direction, may always be removed with little effort, pro- 
vided it be persevered in for a sufficient lapse of time, it suf- 
fices for accomplishing the desired purpose, to place a ligature 
around the neck of the deviating tooth, and then attach this 
ligature to a tooth at a proper distance from that to be removed. 
(PI. XI. Figs. 1, 2, 7.) If, for example, we are required to 
remove a central- incisor, situated anterior to the other teeth, 
we should pass a ligature of proper size around the anterior 
part of the neck, then bring it around the internal faces of the 
two cuspidati, and tie around their anterior faces. If the ligature 



140 



MAURY's DENTAL ART. 



be changed two or three times a day, and tightened at each 
time, the adjustment of the tooth can be effected in two weeks 
at most. The tooth should then be retained in its new posi- 
tion for some months by means of a ligature, or, which is 
better, with a thread of aloes, until the alveolar walls around 
the tooth shall have attained sufficient solidity to retain it in 
its place. We employ in this operation small crotchets or 
hooks, to prevent the ligatures from slipping down on the 
gums. (PI. XI. Figs. 3 to 6.) This mode of regulating the 
teeth is simple and sure. 

Gold or platina plates have also been used for this purpose, 
the manner of application of which was somewhat difficult; but 
this practice has grown into disuse, as it was not always prac- 
ticable, and the results were not always as prompt and efficient 
as by the mode already described.* 

When persons have been unwilling to endure the incon- 
veniences arising from the use of the ligature or plate, an ope- 
ration still more painful has been resorted to. This consists 
in luxating the tooth ; but this operation should only be per- 
formed by an able dentist, since it is not unattended w^ith 
inconveniences. The vitality of the tooth may not only be 
destroyed in the operation, the gums lacerated, the alveolo- 
periosteum injured, and the alveolar processes fractured, but 

* Gold plates have been found to be very useful in the correction of irregu- 
larities of the teeth. Sometimes the incisores are situated so far back in the 
arch, that, at each occlusion of the jaws, they shut behind the inferior teeth. 
This is very difficult to remedy, and the best manner of effecting it is to adopt 
the plan recommended by Mr. Fox. It consists of a gold bar, about the six- 
teenth part of an inch wide, and of a proper thickness adapted to the curvature 
of the jaw, and fastened to the temporary molar on each side. The jaws are to 
be kept from coming entirely together by means of metallic caps placed upon 
the molares ; two holes are then to be pierced in the gold bar opposite each 
deviating tooth, a silken ligature is now to be passed around each of these, 
and through the holes opposite to them, and tied. The ligatures should be 
renewed every two or three days until the teeth have been brought suffi- 
ciently far forward, to close anterior to the inferior teeth ; the caps and gold 
bar may then be removed. 

If only one of the incisores is placed too far back in the arch, a guttered 
plate may be adapted to the inferior arch, and upon it, opposite the irregular 
organ, an inclined plane should be soldered. M. Catalan, we believe, first 
recommended a fixture of this kind. It is simple, and will always ensure 
success when judiciously applied. — S. / 



HYGIENE AND THERAPEUTICS. 



141 



the tooth itself may be broken ; and it may happen that he will 
extract it in spite of every precaution. 

Removal of Dental Tartar, and the Instruments proper in the 

Operation. 

We have said, in another place, that simply a brush, im- 
pregnated with a suitable dentifrice, is commonly sufficient to 
preserve the cleanliness of the mouth ; but means so simple are 
not always sufficient, especially when tartar accumulates be- 
tween the teeth, where even the brush cannot penetrate, and 
when it accumulates, as it often does, upon the interior face of 
the anterior teeth of the inferior jaw. Instruments proper for 
its removal must then be had recourse to. 

The removal of tartar requires address, care and precaution, 
but is not at all painful : it should be practised as often as this 
substance amasses itself upon the teeth. 

The details into which I shall enter before pointing out the 
manner of removing this substance, will, no doubt, appear to 
some persons very minute ; but they are essential to the den- 
tist who wishes to obtain the confidence of the public. 

Before commencing this operation, every thing that it is 
proper to use, should be in perfect readiness. The seat should 
be adjusted to a proper height. It will be well also to pay 
such regard to cleanliness, and neatness as to attract the appro- 
bation of the patient. The instruments to be used are for the 
most part shaped like gravers, hooks, &c. They should be 
very clean, well tempered, and have a fine edge. In this ope- 
ration the dentist should also pay particular attention to the 
cleanliness of his hands; but it is by no means necessary that 
they should be dainty and white. The end of a towel should 
be folded around the hand he is about to place on the face of 
the patient. If the mouth he is required to operate on, be in 
a disagreeable condition, he should avoid spitting, or do it in 
such a manner that the patient should not perceive the motive. 

In cases where the odour emitted from the mouth of the 
patient is highly offensive, it may be ameliorated by aroma- 
tizing the water, with which he should be directed to wash his 
mouth from time to time. 



142 



maury's dental art. 



After having taken all the foregoing precautions, and placed 
the patient in a proper position, and laid upon his shoulder a 
towel intended to wipe the instruments, he may proceed to 
remove the tartar in the following manner. 

The dentist, standing upon the right of his patient, takes a 
rugine, and holding it as he would a writing pen, commences to 
clean the inferior central incisores. The mouth being open, 
the index finger of the left hand serves to depress the lower 
lip, and forms a support to the ring finger of the right hand ; 
the operator then insinuates the instrument beneath the tartar, 
and detaches it in fragments from below upward. This process 
is repeated upon the whole of the anterior sides of the inferior 
teeth. To remove the tartar from the posterior surface of 
these teeth, the patient's head should be inclined a little for- 
ward, and still depressing the lower lip with the index finger 
of the left hand, the ring finger of the right hand, resting upon 
the crown of one of the incisores, the tartar should be removed 
as before described, but by means of a curved instrument. 

To clean the teeth of the superior jaw, the left hand should 
be passed around the neck of the patient, and the superior lip 
should be elevated with the index finger. The ring finger of 
the right hand should rest upon the crow^n of the tooth adjoin- 
ing that to be cleaned, and with the instrument the tartar 
should be detached from right to left, and vice versa, observing 
the contour of the gum and avoiding to chafe it. The tartar 
is easily detached from the molares with instruments of proper 
shapes. 

The posterior sides of the superior teeth, particularly the 
incisores and cuspidati, rarely have tartar upon them, because 
the continual action of the tongue upon them in mastication 
and pronunciation prevents its accumulation. Notwithstanding 
the greatest care in cleaning, the teeth of some individuals 
will retain a yellow hue, which is in truth their natural colour. 
It would be useless in such cases to endeavour to make these 
appear white by scraping them. Should the instrument glide 
over smooth and glassy concretions, these may be removed 
by being rubbed with a piece of soft wood and finely powdered 
pumice stone. There are other precautions necessary to be 
observed to clean the teeth properly, but they are too minute 



HYGIENE AND THERAPEUTICS. 



143 



for description, but which will be learned from experience. 
We would merely add, that from time to time we should di- 
rect the patient to rinse his mouth, and thus relieve him for a 
brief time, and also cause him to expel portions of tartar that 
have been detached. We should, on concluding this operation, 
direct him to clean his teeth with a soft brush and a powdered 
dentifrice, reminding him of the advantage of giving to the 
brush a rotary motion in order to clean them thoroughly. 

Manner of Filing Teeth. 

The use of the file is necessary to remove superficial caries, 
and to equalize and separate teeth that are too long and too 
much crowded, and the disproportion of which will not allow 
of the exact adjustment of the jaws. It is also designed to 
remove asperities and inequalities produced by caries and frac- 
tures of the teeth, and the presence of which incommodes and 
injures the tongue, cheeks and lips. The file is also used to 
prepare the roots of teeth for artificial crowns. Files used 
for this purpose are half round, and sharp or blunt at their ex- 
tremities. Those intended for separating the teeth have two 
cutting surfaces, and are of various shapes and sizes, according 
to the teeth to be filed. They are narrow, flat, and sometimes 
curved. The latter we frequently use to remove lateral caries 
from the incisores and cuspidati. By means of a file carrier, 
we are able to file the molares with as much facility as we can 
the incisores. 

Whatever be the object for which teeth are filed, the 
patient should be properly seated and the operator should 
stand at his right. If, for example, we wish to remove super- 
ficial decay from the lateral side of a tooth, we should first 
examine if the contiguous side of the adjoining tooth be de- 
cayed also. If this be not the case we should use a safe-sided 
file, presenting its cutting side to the decayed tooth. If there 
be decay in both, we should use a file having two cutting sides. 
The action of the file should be gentle but firm in all cases. 
Should this instrument be caught between the teeth, becoming 
tightened, we should gently disengage it. If the decay be 
superficial, we should entirely remove it; but if it extend to 



144 



maury's dental art. 



the dental cavity, it should be separated sufficiently from the 
neighbouring tooth, that the disease may not be communicated 
to it. The soft parts of the decay should then be detached, 
and the cavity cauterized.* The tooth should then be plugged. 

The curved form of our file enables us to remove a great 
portion of the posterior part of the teeth, which is the chief 
seat of decay in the incisores and cuspidati. To obtain the 
same result with a straight file we are obliged to make a large 
separation, and uselessly file away a portion of the anterior 
side of the tooth, and thus give it an unseemly appearance. 

When a tooth is well filed there will remain no portion of 
the cavity, and a smooth surface should be left. 

The manner of using a file upon the superior teeth is very 
simple. The operator should hold the instrument between the 
thumb and index finger of the right hand, and passing his left 
arm around the head of the patient, and raising the lip with 
the fingers of the left hand, he should proceed to file the tooth, 
supporting the right hand by resting the little finger upon the 
most convenient tooth in the inferior jaw. The file should be 
frequently dipped in water, which in cold weather should be 
warmed, in order to prevent the instrument from becoming 
choked up, and also to keep it at a uniform temperature, as its 
action will produce an injurious degree of heat. In filing the 
lateral surfaces of the teeth we should never omit leaving a 
shoulder near the gum, in order that the teeth may not approx- 
imate again, which, without this precaution, would generally 
happen. 

In subjects of forty years of age the incisores and cuspidati 
are often above the level of the other teeth, and on this account 
become loose. We would recommend the filing of these 
teeth, as by being shortened they may be exempted from such 
injury. They generally become solid in their sockets after 
this operation. An example of this is furnished in the follow- 
ing case extracted from our Manuel du Dentiste, 

We were applied to by a person fifty years of age, who had 

* The whole of the decayed part should be removed. To prevent misap- 
prehension, it may be proper here to refer to our objections to the cautery, 
in a previous part of this work. The reader will observe this in subsequent 
recommendations of this practice by the author. — S. 



HYGIENE AND THERAPEUTICS. 



145 



had for ten years a large accumulation of tartar upon the six 
anterior teeth of the inferior jaw, and which had deprived the 
teeth of their gums for at least five lines below their natural 
level, and so loosened them, that the least pressure with the 
finger would have been sufficient to occasion them to fall out. 
We illustrate (PL XIII. Fig. 9,) a case somewhat similar. 
Effects of like character often result from the immoderate use 
of antisyphilitic remedies. We commenced our treatment by 
first removing the tartar, and then temporarily securing those 
teeth to their neighbours by means of silken ligatures. We 
then made a horizontal groove at that point at which we de- 
signed to cut them, and afterward severed them by means of 
the excising forceps. The surfaces of these teeth were then 
smoothed off with a file, and a ligature was again applied. 
The patient was recommended to gently brush his teeth and 
gums several times a day with a healing liquid composed of 
equal parts of the tinctures of rhatania and bark, mixed with 
an adequate proportion of water. A month after, the gums 
and teeth of this person had become firm, and the latter have 
since continued firm in their places. 

In this operation a narrow file is commonly used having but 
one cutting edge, and thus acting like a saw. We should, 
however, be very careful when we meet with teeth that are 
much longer than the rest. We should not in such cases 
rashly cut off as much of the tooth at one time as we wish to 
remove, as from its sensibility unpleasantness may be experi- 
enced. Some persons, in fact, experience an unaccountable irri- 
tation ; others experience local pain, and a nervous agitation 
through the whole body. In such cases the operation should 
be deferred for some months, and again be resumed to be per- 
severed in very slowly until the tooth has finally been reduced 
to its proper length. Using these precautions the object may 
always be accomplished, although it would be impossible to 
perform it at a single operation. By leaving an interval of 
three or four months between each attempt at reducing the 
tooth, the bony substance will lose its acuteness of sensibility, 
and thus admit of the renewed operation at each time. If, 
however, we are very anxious to effect the object at once, we 
13 



146 



maury's dental art. 



may possibly succeed by cauterizing it successively as the ex- 
posed part becomes sensitive. 

Roots destined to receive artificial pieces are generally pre- 
pared with the half-round file. We also with this file remove 
osseous eminences and asperities that may injure the soft parts 
of the mouth; or we may first remove these asperities with the 
excising forceps, and afterward smooth them off with the half 
round file. 

The use of the file has been condemned as a means of re- 
moving decayed portions of the teeth, and several noted prac- 
ticiens have maintained that, from having portions of their 
enamel removed, the teeth become more susceptible of decay. 
We are far from concurring in this opinion, and if these prac- 
ticiens had been careful and minute in their observations, they 
would have observed that teeth decay after filing only when 
they are permitted to grow together again; but this may be 
prevented by the mode of filing we have already indicated. A 
tooth may with safety be filed away as long as the patient can 
endure the operation, and until all particles of decay are re- 
moved, and no cavity is suffered to exist, provided that enough 
of its substance be still left to protect its internal part, or pulp; 
and as we thus remove the cause of the progressive disease, it 
is erroneous to suppose that the use of the file will tend to pro- 
duce disease. W^e would assert, that where partial decay is 
thus removed, the teeth that are subject to this operation may- 
be preserved in health as long as those that have never been 
affected. 

Unfortunately, dentists do not make suSiciently free use of the 
file. This, no doubt, results in part from the difficulty of pro- 
curing good instruments, and such as can be applied with fa- 
cility to the teeth in the posterior part of the mouth. There 
can be no danger from this operation, if the file be guided 
by a skilful hand. It is a precious instrument for the removal 
of decay. Its employment is even useful for the rem.oval 
of decayed portions of the deciduous teeth, which should al- 
ways, if possible, be preserved to the period of the natural 
molting. We cannot use it too often for the preservation of 
teeth, particularly at an advanced period of life, when so many 
different causes contribute to deteriorate them. 



HYGIENE AND THERAPEUTICS. 



147 



The permanent teeth should not, however, be filed previously 
to the thirteenth or fifteenth year, as from the thinness of their 
parietes, and the large size of the internal pulp, they are not 
capable of enduring the action of the file. If, as it happens 
with some children, the teeth manifest a disposition to decay 
at the time of cutting, which may be inferred from the thinness 
of their enamel, their bluish colour, mal-arrangement, &c., we 
should not then hesitate to use this instrument to efiect their 
separation. To understand thoroughly the use of the file is 
not an easy matter. It does not consist in drawing the file 
backward and forward, or directing it to the various parts of 
the tooth,but we must also use it without jarring the organs, and 
cause it to cut in the desired direction. Hence, we can learn by 
practice only how to perform this operation well. We should 
endeavour so to direct the file as to cut in an angling direction 
upon the tooth, in order that a firmer hold may be taken, and 
the object thus more speedily effected. Files that are cut ob- 
liquely act more gently, though slower, than those that are 
cross-cut. 

Teeth filed by a skilful dentist have the appearance of never 
having been touched with such an instrument. To give them 
this appearance, the corners, angles, and cutting extremities 
are rounded, and smoothed off* with a very fine file. 

Cauterizing the Teelh.^ 
The circumstances under which we are obliged to cauterize 
teeth to preserve them are numerous. It is resorted to to 
destroy the dental nerve when it has become painful, and 
to arrest or dry deep-seated or superficial caries. Fire and 
caustics are the means of cauterization to which the dentist 
generally has recourse; the actual cautery is that most used. 

* For our opinion of the suitableness of the actual cautery for the purpose 
of destroying the nerves of teeth, the reader is referred to our remarks at page 
67. Those remarks have regard to the means of merely obtunding the 
sensibility of a tooth for the purpose of plugging, as well as for the purpose 
of destroying the nerve. 

The author, however, prefers the actual cautery to the use of the concen- 
trated acids. In this we agree with him; but neither can be too strongly 
deprecated. The only application of this agent in which we can concur with 
the author in his recommendations as above is for the suppression of obstinate 
hemorrhage after the extraction of teeth, in cases in which no other means 
will apply. — S. 



148 



maury's dental art. 



We would, however, remark that the application of fire is 
insufficient; it has been known to augment instead of re- 
lieving the pain, and it has been also remarked, that when the 
decay is far advanced this means will render the affected tooth 
brittle and less capable of preservation. Some nervous persons 
prefer having the diseased organs extracted to submitting to 
this operation, as the pain attendant upon it is very acute. We 
are far, however, from disapproving of the actual cautery. We 
think that from its energetic action the happiest results may 
be obtained. It may suddenly subdue violent pain, and arrest 
superficial decay, and is of the highest utility in arresting he- 
morrhage. This mode of cauterizing is very useful in the in- 
cisores and cuspidati, which are sometimes so extensively de- 
cayed that we are unable to remove the decay, lest the tooth be 
rendered too weak. Such teeth may be cauterized from time 
to time to arrest the progress of the affection. 

When we wish to destroy the dental nerve with the actual 
cautery, we should employ a platina stylet three inches long, 
adapted to a handle, and having at about eight lines from its 
extremity an ovoid enlargement, in order to retain the necessary 
heat to effect the desiccation of the nerve. This bulb should be 
moveable, that the point of the instrument may be lengthened. 
When we wish to use it, we should heat the stylet and its bulb, 
and in this condition insert it promptly into the dental canal, 
giving it a slight rotary motion, and then immediately withdraw 
it. We have pursued this plan for fifteen years with uniform suc- 
cess. It is seldom that a second application is necessary, but we 
at all times entirely destroy the nerve. The actual cautery is 
particularly applicable to the roots of the incisores, cuspidati 
and bicuspides. If water be taken in the mouth, and no pain 
be occasioned by it, we may be sure that the operation has 
been successful. We should then remove the cauterized parts 
of the tooth, and fill the cavity with cotton saturated with spi- 
rituous liquor; and after drying the interior of the cavity it 
may be plugged. In cases in which we do not wish to apply 
the actual cautery for this purpose, we sometimes resort to ano- 
ther mode. This consists in the extraction of the nerve. To 
accomplish this, we take two or three pieces of fine gold or 
platina wire, and attach them to a handle. These wires should 



HYGIENE AND THERAPEUTICS. 



149 



then be insinuated to the extremity of the root, and by a slight 
rotary movement we are, in the first attempt, often enabled to 
extract the nerve. We do not by this method disorganize the 
soft parts of the dental cavity, and the tooth is in readiness to 
be plugged. This latter practice is the most effective means of 
wholly alleviating the pain. It is particularly advantageous in 
preparing a root to receive an artificial crown. 

Before cauterizing a tooth that is much decayed, we should 
endeavour to remove with a file the greater portion of the 
diseased part, and by means of an excavator the soft parts 
within the cavity should also be taken away; the cavity should 
then be well cleaned and dried with a lock of cotton, and the 
cautery should be applied to the affected part with great care, 
and should be repeated several times, according to the extent 
of the decay. If, after these precautions, the disease still pro- 
gresses, we should again resort to the cautery, and afterward the 
tooth may be plugged with advantage. 

The instruments employed in cauterizing are of various 
forms according to the different parts to be operated on. That 
most commonly used is a flat or round hook. It is necessary, 
when operating, to always have several in readiness, in order 
to change them if necessary. This, however, should be avoided 
as much as possible, that the fears of the patient may not be 
excited. The flame of a wax candle or spirit lamp is sufficient 
to give it a proper degree of heat. These instruments are 
generally affixed to a metal handle by means of a spring or 
catch. When it is proper to heat them to a high temperature 
a cork handle will be of service, as this is a bad conductor of 
heat. 

Many persons cannot endure a heated iron applied to their 
teeth ; and recourse must in such cases be had to the second 
mode of cauterizing, which is by the use of caustics. Liquid 
ammonia, and sulphuric or nitric acid, are the substances em- 
ployed for this purpose. The manner of using these is very 
simple. A piece of cotton of the size of a pin's head, satu- 
rated in one of these ingredients, and placed in the cavity of a 
tooth, will effect this purpose. Another piece of cotton should 
then be placed upon this, and the whole should be covered 
finally with some soft bees-wax. We should use much caution 

13* 



150 



maury's dental art. 



in the use of these liquids. They have disadvantages, as they 
tend to soften the osseous substance of the teeth. If negli- 
gently dropped upon the adjacent teeth or soft parts of the 
mouth, they will occasion the patient inconvenience and pro- 
duce injury. The inflammation of the alveolo-periosteum, 
may also be increased by the use of the acids as well as by the 
actual cautery when used at a very high temperature. Hence, 
we repeat, they should be resorted to as seldom as possible; 
for, although they may give rise to less terror than the actual 
cautery, this advantage does not compensate for the injury that 
may be inflicted. What we have said of acids will equally 
apply to the nitrate of silver. 

If the extraction of the nerve, or cautery by fire or the 
acids, be impracticable, we must then obtund the nervous sen- 
sibility by means less violent. The means we would recom- 
mend appear to act upon the principle of escharotics. These 
substances are myrrh, incense, extract of opium, ether, essence of 
cinnamon, cloves and mint, and other essential oils and highly con- 
centrated tinctures. 

Any of the substances here enumerated will tend to con- 
tract and obtund the nerve, and if not sufiiciently energetic to 
destroy it wholly, the irritation produced by them will alleviate 
and sometimes remove the pain. If this method do not suc- 
ceed, no harm at least will result from it, and in hopes of suc- 
cess its trial will always be advisable. 

Manner of Plugging Teeth. 

When, by the means we have already indicated, we have 
deprived the dental nerve of its extreme sensibility, we must 
use some means to arrest the progress of decay. The dental 
ai't furnishes us with a method of doing this, which we daily 
practise. It consists in introducing into the cavity formed in 
the tooth leaves of metal or other substances until it be com- 
pactly filled. 

This operation is called plugging the teeth. Lead was for- 
merly exclusively used for this purpose. It is an operation of 
great importance, and we shall treat of it in detail. 

A tooth may be plugged when decayed, if there be no dis- 



HYGIENE AND THERAPEUTICS. 



151 



charge of matter from the dental canal, and if the presence of 
heat and cold, the contact of an instrument, or the retention of 
particles of food in the cavity, do not produce pain. Before 
operating, we should always inform ourselves whether the 
tooth presents such condition. If it do not, we may occasion 
pain so acute as to render the tooth incapable of being pre- 
served by this mode. 

The sound or excavator is an instrument proper for exa- 
mining the cavity of a decayed tooth. We, in general, use 
the double spiral excavator, because its various curves enable 
us to introduce it into a cavity upon any part of the tooth. It 
is particularly useful to reach the lateral surfaces of the molar 
teeth. This sound or probe, is very simple, consisting of a 
piece of wire having its two extremities terminating in a 
semi-circle, one inclining to the right and the other to the 
left. When the operator is convinced, from examination, that 
there is no sensibility in the cavity of the tooth, and that it is 
larger internally than externally, he may then proceed to plug 
the tooth. The material used may be lead, tin, gold, or platina 
leaf, or fused mastic; sometimes wax, mastic, or compositions 
capable of resisting the action of the saliva. These various 
materials are introduced into the cavity of the tooth, and ren- 
dered so compact as to effectually exclude the air and saliva. 
If the operation be well performed, in good time, with metal- 
lic substances, the teeth may be preserved for a number of 
years, and even through life. Lead, of all the substances which 
we have enumerated, is most generally used for plugging teeth; 
but as this metal oxydizes and becomes black as soon as applied, 
we prefer the use of tin foil, as it is prepared by the gold- 
beaters. Gold and platina are still better, but these metals 
should have a certain degree of malleability. As regards wax 
and other compositions that are used for this purpose, they are 
not sufficiently solid to be retained for any length of time, and 
their use is now rejected. There are some cases, however, 
where their application becomes^ indispensable, particularly 
when we wish to conceal upon the anterior teeth a cavity 
which the presence of metal would expose. When this mode 
of preservation is employed with discernment, we may hope 
to obtain success, and for this purpose we may advantageously 



152 



matjry's dental art. 



use the fusible metal of Darcet, used for the first time by our 
confrere, M. Regnart, who has improved it by adding a tenth 
part of mercury. This composition consists of 

Bismuth, 
Lead, .. 
Tin, ... 

It is fusible at the temperature of boiling water. It is used in 
the following manner: — 

After having excavated the tooth, and cleaned, dried and 
prepared the cavity for plugging, a piece of the composition of 
adequate size is to be introduced, and a probe, or plugger, is 
to be made hot enough to cause this to melt. With this instru- 
ment the amalgam should be pressed compactly into the tooth, 
and, when hardened, its surface should be smoothed oflf. This 
amalgam becomes very hard and solid. We would, in certain 
cases, prefer it to lead, as it accommodates itself better to the 
shape of the cavity. JNIany dentists use this article exclusively, 
the advantage of which we have made known to many of our 
confreres. We are much indebted to M. Regnart for this 
discovery.* 

When we have discovered that the tooth is in proper condi- 
tion to be plugged, we should commence with an excavator to 
remove particles of food or other foreign bodies, and all the 
soft and decayed portions of the tooth, and to form little 
notches and irregularities within the cavity that the metal may 
be more easily retained. A piece of cotton saturated with alco- 
holic liquor or essential oil should be then introduced into the 

* For this operation, gold is the only substance known that can be perma- 
nently relied on; although there are cases in which tin and even lead may be of 
temporary advantage when employed with skill and judgment. I regard 
cements (paste) fusible metals, amalgams, succedaneums, and all other sub- 
stitutes for the above named metals, as impositions on the public, never 
having seen a single operation, in which these substances were employed, 
which would not have been more permanent if even lead, the poorest of the 
above named metals, had been used; because it is less subject to decomposi- 
tion and oxjj-dation, to say nothing of the poisonous qualities of the mercury 
which most of the others contain. I have never known a perfect master of 
the art of stopping teeth, either to employ or recommend the substances 
which I here condemn ; and I believe the use of them is almost wholly confined 
to those persons who are unacquainted with this nice and difficult art. E. 
Parmly.— S. 



8 parts, 
5 " 
3 « 



HyCIENE AND THERAPEUTICS. 



153 



cavity, and afterward a piece of dry cotton should be intro- 
duced in order to absorb tlie moisture. After having in this 
manner perfectly dried the cavity, the metal or other substance 
may be inserted. A sufficient quantity of the metal used should 
be formed into a tube and urged into the tooth by means of a 
suitable instrument. We should then press it firmly and con- 
dense it by means of a plugger. When the cavity has thus 
been made completely full, we should remove whatever little 
excrescent parts there may be, and burnish the surface well. 
In filling cavities situated upon the crowns of teeth, the metal 
should not be cut off even with the tooth, as it will become 
more firmly condensed in the process of mastication. Jt will 
be found that this operation is difficult, and often impractica- 
ble, particularly if the disease be situated upon the lateral sur- 
faces of teeth that are crowded, or upon the posterior surfaces 
of the molares. If the teeth themselves be very sensitive, we 
should fill their cavities with cotton dipt m essential oil. 
This should be renewed every day. This will protect the 
nerve from the impressions of the atmosphere, and by absorb- 
ing the pus that may be discharged from the dental canal, it 
will prevent the tooth from being offensive. 

Notwithstanding the utmost precaution that may be taken in 
this operation, it is not uncommonly followed by severe pain, and 
sometimes considerable inflammation, which may terminate in 
abscess. If this pain continue, w^e should remove the plug and 
allay the irritation by the means commonly indicated. If 
there be no discharge from the dental canal, we may again plug 
the tooth. When the tooth is sensitive to the contact with a 
foreign body, we should in some manner accustom it to sup- 
port its presence, which may be done by performing the ope- 
ration at various times. We should not at first press the metal 
sufficient to exclude the air and moisture. We may some weeks 
after press it again, and when we discover that in this manner 
the tooth has lost its sensibility, we may remove the plug thus 
coaxed in, and insert a plug well at one sitting. This opera- 
tion is generally very delicate, and requires patience and per- 
severance. 

Manner of Luxating Teelh. 
When the patient is desirous of preserving a tooth which 



154 



maury's dental art. 



is the occasion of pain, we sometimes have recourse to 
luxation, and afterward replace it in its primitive position. 
The pain may in this manner be often relieved, but success 
will not always attend such operation; nor should it be prac- 
tised under all circumstances. We may, however, attempt the 
luxation of a tooth if it be painful, and if it be sufficiently solid 
to be in no danger of breaking by the operation, or when it has 
taken an improper direction. This operation should in general 
be only practised upon young and healthy persons, and whose 
gums are in a healthy condition. It is also necessary, before per- 
forming this operation, to acquaint ourselves with the consti- 
tution of the subject, as luxation will not be of use when prac- 
tised upon persons of weak constitution, whose gums are soft 
or turgid. The tooth, under such circumstances, would never 
become firm in its socket, and its extraction would soon become 
necessary. It should be practised only upon certain teeth and 
at a certain age. (1.) The incisores, cuspidati and anterior bi- 
cuspides are the teeth that may be luxated. (2.) The most 
favourable periods of life appear to be from thirteen to thirty 
years of age. It is more difficult to luxate than to extract a 
tooth, because the movements during the operation should be 
very moderate, that the vessels and nerves distributed to the 
part may be lacerated as little as possible, and that the alveolar 
border may not be fractured. It is well known that a luxated 
tooth cannot regain its primitive solidity in the socket after 
having been entirely removed; for, if once extracted and re- 
placed in its socket, there is little probability of its resuming 
its functions of life. We shall comment on this subject when 
treating of transplanting teeth. 

The manner of luxating a tooth differs but little from that of 
extracting; it is simply to rupture the dental nerves, and by 
the guidance of the hands to cause it to take the required di- 
rection. The operation being performed, we are sometimes 
obliged to retain the tooth in its new position by attaching it 
to an adjoining tooth until it becomes firmly fixed in its socket. 
The patient should be directed not to masticate solid aliment, 
and to make use of tonic gargles. Luxation, though practica- 
ble upon the anterior teeth, should not be attempted upon the 
molares; it may occasion bloody effusions in their sockets, and 



HYGIENE AND THERAPEUTICS. 



155 



deposites which will necessarily require the extraction of the 
tooth. These teeth not regaining their attachment, will often 
occasion fistulous openings, and should they remain after the 
operation, it will only be for a few years. Evils of this kind 
are more than sufficient to cause us to abandon a practice that 
holds forth so little prospect of success. We sometimes, how- 
ever, luxate a decayed bicuspid, and shortly thereafter plug it. 
The only inconvenience resulting from this is a slight sensibility 
at the roots. 

Of accidental luxations produced by external violence, we 
need only remark that the mode of treatment is the same as in 
the preceding cases. When it happens that several teeth are 
thus luxated, it will be sufficient to replace them and tnaintain 
them properly in their positions in order that they may regain 
their attachment* 

Manner of Extracting Teeth. 
As soon as the dentist concludes that a tooth cannot be pre- 
served by any of the foregoing means, he should propose extrac- 
tion without hesitation, and should perform no other operation 
to prolong its retention. He should, however, apprize his patient 
that, no matter what may be the skill of the operator, or the ex- 
cellence of the instruments used, this operation is always at- 
tended with pain. There are few persons who attain to advanced 
age without having at some time to submit to it. Unfortunately 
it appears to the vulgar eye to be of easy performance, as it is 
daily executed by the most illiterate dentists, and by empirics 
who sometimes have discretion enough to shun cases that may 
be attended with difficulty. But the evulsion of teeth requires 
practice and manual dexterity, and in many cases the utmost 

* It will be perceived that the author's recommendations of this practice 
are qualified; but it is still proper that we should remark that it is now uni- 
versally condemned by scientific dentists. When a front tooth has been 
accidentally loosened in its socket the application of ligatures to hold it firmly 
in its place, and the use of antiphlogistic remedies to the gums, if called for, 
should be resorted to. But even in this case, if the alveolus should be found 
much injured, or if the luxation of the tooth be sufficient to sever the nerves 
and vessels entering at the apex of its root, its extraction would be the more 
judicious step. We say this, too, with a knowledge of the many cases that have 
been narrated of the replacement of teeth in their sockets, that had been com- 
pletely withdrawn. — S. 



156 



matjry's dental art. 



prudence and discretion will require the aid of an accurate 
knowledge of the diseases of the teeth and of the anatomy of 
the mouth. 

When the decay has penetrated to the dental canal, when 
the tooth is sensitive to the impressions of heat and cold, and 
when it occasions pain in mastication, it is customary to per- 
form the operation of extraction. As the loss of one or more 
of the teeth, however, cannot be regarded with indiflference, 
we cannot be too circumspect when we are desired to perform 
this operation. The dentist will, indeed, be frequently led into 
error if he pays regard to the representations of his patients at 
all times, and extracts all the teeth that may be pointed out to 
him as the causes of pain. The patient is very often wholly 
deceived on this point, and will point out, as the seat of pain, a 
tooth in the superior jaw when suffering, in fact, from one in 
the inferior; and a sound tooth is as likely to be pointed out as 
one that is decayed. Sometimes, indeed, the pain appears so 
general that the patient believes all his teeth to be affected. 

The dentist who has regard for his reputation, should, in 
such cases, act very prudently, in order not to be deceived into 
a serious error: he should carefully examine all of the teeth 
supposed to be affected, making use of a dental mirror. Each 
suspected tooth should be tested by being shaken with the 
finger, and if the seat of greatest sensibility be not thus ascer- 
tained, let the teeth be tapped severally with the plugger or 
other hard body; should this not lead to the discovery, let the 
patient then be directed to take cold water in his mouth. 
When convinced of the existence of disease, and having, by 
some such means as are herein described, identified the indi- 
vidual tooth that occasions the pain, the practicien may pro- 
ceed to extraction, but not till then, by means of instruments 
intended for this purpose, and which we shall describe after 
having pointed out certain general rules for their application. 

Whatever may be the method adopted to extract a tooth or 
root, there are certain precautions that cannot be too strictly 
observed in order to ensure success. Having taken a proper 
hold with the instrument, we should proceed slowly and cau- 
tiously, depending more on skill than force; thus we may 
avoid fracturing the tooth or alveolar process, bruising the 



HYGIENE AND THERAPEUTICS. 



157 



gums, or loosening the adjacent teeth. The movements in 
extracting should generally be moderate, but firm, and con- 
tinued. Most dental authors direct us to apply the force 
required in the direction of the roots of the tooth to be re- 
moved; thus it may be drawn obliquely, or turned upon its 
transverse axis by depressing the crown, and at the same time 
elevating the root. We may even take a tooth out of its 
socket laterally by applying sufficient force; but whatever may 
be the class of teeth we wish to extract, luxation must alw^ays 
precede extraction. Thus the tooth should be grasped firmly 
by the neck, as low down as possible, and, by being inclined 
inwardly or outwardly, its connexion should be severed. It is 
better, however, to luxate and extract the tooth from within 
outwardly; the form of most instruments requires this, except 
of the improved key, which will act in either way with equal 
advantage, particularly in the extraction of the molar teeth. It 
is difficult with the old key to extract these teeth, and when 
we attempt it, we may occasion extensive fracture of the alveo- 
lar process, from which sometimes proceeds a hemorrhage 
difficult to arrest. The last molares of the inferior jaw are 
sometimes so situated that the base of the coronoid apophysis 
forms, opposite their roots, a sharp, yet firm ridge, which will 
expose us to such accident, should we attempt to remove the 
tooth inwardly. 

The modifications which we have made upon the key of 
Garengeot, are such that we may often with this instrument 
extract the last molar outwardly when this tooth is hidden in 
the base of the coronoid apophysis. These teeth may also be 
extracted in the opposite direction with the same key. If the 
operation be well performed we need hardly fracture the al- 
veolus; this accident is serious, however, only when the maxil- 
lary artery is ruptured by it, which, fortunately, scarcely ever 
happens. A skilful dentist will, at first sight, perceive if a 
tooth be difficult to extract, and, in such case, he will acquaint 
his patient of it, but in such manner as not to alarm him; and 
should the operation not prove as successful as desired, the 
operator will not then be censured. Such intimation should 
particularly be given when the crown of the tooth is so much 
decayed as to present a frail hold for the instrument. On ex- 
14 



158 



mauky's dental art. 



tracting teeth which will be likely to produce much pain from 
the divergence of their roots, as is usually the case when the 
crowns are very low, the difficulty of the case should also be 
revealed to the patient. In performing this operation v^^e may, 
it is true, remove a portion of the alveolar process, but this 
accident is not of serious import. 

We have here, in a general manner, pointed out the mode 
of extracting teeth. We shall now examine the instruments 
used for this purpose, and the manner of their application. 

INSTRUMENTS FOR THE EXTRACTION OF TEETH. 

Of all operations in dental surgery, the extraction of teeth 
may be supposed to require the greatest variety of instruments. 
We have, however, found that inconvenience resulted from an 
excessive number of these, and have endeavoured to reduce it. 
Five or six will in general suffice. It is only necessary to 
know the use of these, and to learn, by practice, the skilful 
application of them. A good practicien seldom, indeed, makes 
use of more than two or three, and these being familiar, he is 
dexterous in the exercise of them. Those generally used are 
the following: — 1. The Key of Garengeot, modified; 2. The 
straight forceps; 3, The curved forceps; 4, The curved hawk's- 
hill forceps; 5. The straight hawk's-bill forceps; 6. The lever 
and hook; 7. The elevator. Some dentists also use the pelican, 
fish-tongue, stagfoot, and excising forceps. The use of these 
last instruments is now abandoned. 

Garengeot' s Key, and the Manner of using it. 

Of all instruments intended for the extraction of teeth this 
is the most ingenious. It consists of a handle of adequate 
size, of a shaft forming nearly a right angle and terminating 
in an enlargement, into which are made two slits, and through 
which passes a screw or pin designed to form an axis for a hook 
to revolve upon. This hook is to be applied to the crown of 
the tooth to be removed, and the enlarged part of the shaft, 
into which its opposite end is inserted, forms the fulcrum upon 



HYGIENE AND THERAPEUTICS. 



159 



which the whole instrument revolves in the process of extrac- 
tion. This instrument is particularly useful in the extraction 
of the molares, the crowns of which are capable of enduring 
the force necessary to be applied. 

Having placed the patient in a suitable position, the hook of 
this key is applied to the neck of the tooth in such manner 
as to lodge the crown in its concavity. The fulcrum is fixed 
on the opposite side a little above the extremity of the root. 
Being thus placed, the fulcrum is a little lower than the hook, 
the resistance upon the crown of the tooth, and the support 
upon the opposite side of the alveoli. The power is in the 
handle of the instrument. When all these precautions have 
been taken, and a piece of soft leather has been placed in such 
manner as to protect the gum from injury, with a rotary motion 
of the key, we extract the tooth either inwardly or outwardly, 
as we may have previously determined upon. The tooth is 
often extracted with this instrument alone; but sometimes, 
after having luxated it, it is prudent to suspend the effort, lest 
we break away the alveolar process and lacerate the gums. 
The operation in such cases should be completed by means of 
straight or curved forceps. A rotary movement should now 
also be adopted so as not to remove the portion of the alveolar 
process that m.ay have been fractured, nor to tear away the la- 
cerated gum. It is important that the operator should not be 
too precipitate, nor apply too much force with this instrument, 
as the evils described may also be produced with it. 

Although Garengeot's key is the best instrument for the 
extraction of the molares, it may be perceived, from what we 
have already said, that it has its inconveniences, which it is 
proper should be remedied. Jourdain, Bourdet, Come, An- 
• guermann of Leipsic, Messrs. Laforgue and Duval, and many 
other dentists and surgeons, have modified it and made many 
ingenious improvements. We have improved this instrument, 
and called it Garengeofs Key Improved. This, from its con- 
struction, may be applied to in the extraction of decayed teeth 
that present the greatest difficulties. It differs from all the 
modifications and corrections of that instrument up to the 
present day: first, by its handle being moveable; secondly, by 
the curvature of its shaft ; thirdly, by the facility with which 



160 



maury's dental art. 



we may make a fulcrum of the tooth adjoining the one we wish 
to extract; fourthly, by its hook, which nearl}^ describes a 
right angle. We shall describe this new instrument, and ana- 
lyze its parts, and endeavour to point out the advantages which 
it possesses. 

Garengeofs Key Improved. 

The moveable Handle. — This handle is larger than others, and 
the shaft is retained in it by means of a strong spring in such 
manner, that the operator can in a measure contract the instru- 
ment by means of pressure upon this spring. The force of 
the key is in this manner greatly increased. 

The curved Shaft. — The curvature of the shaft forms nearly 
a right angle, and thus we are enabled to witness the action of 
the hook during the process of extraction, and readily discover 
if it slides from the neck of the tooth. This hook should be 
well adapted in size. When it is too large, the fulcrum of the 
key will glide upward to the neck of the tooth and fracture it; 
and if too small, the same accident is liable to occur. Should 
the fulcrum not descend sufficiently low upon the maxilla, we 
are also liable to take hold, with the hook, of the gum and alveo- 
lar process of the opposite side, and inflict injury and pain upon 
them. The curvature of the shaft presents another advantage, 
in enabling us to convey the tooth inwardly by placing the 
fulcrum upon the palatine side of the arch. This we are under 
some circumstances obliged to do, especially if the inner side 
of the tooth be destroyed by decay. The hook is then to be 
reversed, and the fulcrum placed upon the external side of the 
maxilla, for the removal of a tooth that does not require this 
mode of procedure. This key is particularly useful for ex- 
tracting the dentes sapientisB, the alveolar border of which 
does not offer sufficient surface exteriorly for the support of 
the fulcrum of an instrument. It is essential that the hook 
should not be too large, lest the fulcrum should descend below 
the eminence formed by the oblique ridges of the maxillary 
bones, as these would yield sooner than the tooth could be 
drawn. 



HYGIENE AND THERAPEUTICS. 



161 



Point of Support. — This should be directly anterior to the 
tooth to be removed. This is particularly essential in re- 
moving the dentes sapientise of the superior, as well as infe- 
rior jaw. 

Hooks describing nearly right Jingles. — These hooks embrace 
and seize the tooth better than those that describe a semicircle, 
as these latter are liable to slip toward the crown of the tooth: 
and they require more space than the former, and consequently 
oblige the patient to open his mouth widely, which is very 
fatiguing, especially to persons whose mouths are so small, that 
we can with difficulty introduce this instrument as far as to 
the second molar. 

The straight Forceps.—^These instruments should be six or 
eight inches long, their beaks should not be more than seven 
or eight lines in length, and their angles should be rounded. 
The beaks may be made of various sizes, and so constructed 
that their points will almost touch each other. The inner sur- 
faces of these beaks, instead of being denticulated as they 
usually are, should be hollowed out and adapted to the crown 
of the tooth. 

These forceps are in general used for the extraction of the in- 
cisores, cuspidati, and bicuspides. Their handles should be 
straight, and fluted that they may not slip from the hand of 
the operator. 

In using these forceps we raise with the index finger of the 
left hand the lip, placing the thumb upon the crowns of the 
teeth. With the forceps in the right hand we take hold of the 
tooth as far beneath the gum as possible, and pressing sufficient- 
ly hard to be sure that the instrument will not slip, but not 
hard enough to crush the tooth, we should by a semirotary 
movement luxate the tooth, and then draw it perpendicularly 
and a little outwardly.* In certain cases, particularly with 
children, we may make use of a pair of forceps of small size 
with advantage, 

* It is erroneous to advise the luxation of the bicuspides by means of a 
rojary motion. The movement should be outward, inward, and perpendicu- 
lar.— S. 

14* 



163 



maury's dental art. 



The curved Forceps. — These forceps differ from the pre- 
ceding in having their beaks slightly curved. The curvature 
requires that the handles should be longer, and also slightly 
curved, but in an opposite direction from the inclination of 
the beaks. We use these instruments in general to remove 
from the lower jaw teeth that have already been partially ex- 
tracted, and which offer but slight resistance. In extracting 
the teeth of children a smaller pair of the same shape are used. 

In imitation of some English dentists we sometimes use 
large straight and curved forceps for the removal of the inci- 
sores, cuspidati, bicuspides and molares, however firm they 
may be in their sockets. This requires the instruments to be 
large; but the performance of such an operation with these in- 
struments requires much skill and practice. 

The curved Hawks-beak Forceps. — These resemble the straight 
forceps, but have their beaks arched in a direction with their 
handles. The superior beak is six or seven lines in length, 
while the inferior is only five or six. The extremities of the 
beaks should only be a line or a line and a half in thickness. 
This gives them the appearance of a parrot's or hawk's-beak. 
The superior handle is curved in the direction of the beaks as 
is also the inferior, but it is a few lines shorter. The whole 
length of the instrument is about four or five inches. 

These are generally used for the extraction of the incisores, 
cuspidati, and bicuspides, of the inferior jaw. They are used 
in the following manner: — 

The superior beak of the instrument is placed upon the in- 
ternal side of the neck of the tooth, and the inferior upon the 
external side of the neck. Thus adjusted, we should gently 
press the instrument, then work the tooth outward and inward, 
and at the same time endeavour to raise it from its socket. 

The hawks-bill forceps, however, are not very sure in the 
hands of persons unaccustomed to their use; fbr, if the tooth be 
firmly fixed in its socket, it may be fractured. This will not 
be surprising when we reflect that by embracing the teeth pos- 
teriorly and anteriorly with these forceps, the action and point 
of support are upon the same line, and the alveolar walls may 
present resistance equal to the force applied. 



HYGIENE AND THERAPEUTICS. 



163 



These forceps are used for the extraction of the teeth of 
child ren and loosened adult teeth, particularly such as have 
become so from luxation or disease of the alveolar membrane. 

The straight Hawks-bill Forceps. — The model of this instru- 
ment was presented to us by Mr. Nasmyth of London. Its 
use is for the extraction of the anterior teeth of both jaws, and 
it is applied in like manner as the straight forceps. Its larger 
beak should rest upon that side of the tooth toward which we 
wish to luxate it. 

The simple Elevator. — This is nothing more than a shaft 
nearly straight and rounded,, but having a flat and cutting end. 
(PI. XIV. Fig. .2.) 

In using this instrument we should insert it as far as possible 
into the lateral part of the alveolus, and then endeavour to ele- 
vate the root in the direction of the socket. It may be ap- 
plied in many ways, however, and for the luxation and removal 
of certain teeth, as well as for the former purpose. 

The Fish Tongue. — Some dentists use an instrument called 
by this name for the removal of the wisdom teeth. (PI. XIV. 
Fig. 1.) Its name and reference to the plate will sufficiently 
indicate its form. 

The extraction of a tooth is a painful operation, and many 
persons would prefer enduring the pain of toothache for a long 
time to submitting to this operation. It is, however, the only 
sure means of relief; yet we will state that it is sometimes at- 
tended with serious results. The extraction of one or more 
teeth deprives the adjacent ones of a part of their support; 
the alveolar border flattens down; mastication and pronuncia- 
tion become more difficult, especially in subjects of advanced 
age; and the cheeks fall in, giving to the physiognomy an ap- 
pearance of decrepitude. These inconveniences are sufficient 
to induce the dentist to avoid performing this operation, when- 
ever other means can be resorted to of giving efficient relief. 
The other means are those we have already described, as cau- 
terizing or extracting the dental nerve, luxating the tooth, re- 
moving the decayed portions with the file, or by the complete 



164 



maury's dental art. 



excision of the crown after the manner of the American den. 
tists, who, it is said, were the firs! to substitute this practice 
for extraction. 

Excising Forceps. 

Excision of the teeth, which Mr. Fay, American dentist 
resident in London, now practises, consists in cutting off the 
crown of a tooth with a pair of strong forceps. These forceps 
maybe curved or straight, and their beaks have a cutting edge. 
With these instruments we can excise the largest teeth with- 
out danger of splitting them. PI. XV. Figs. 1, 2, represents 
two pairs of these forceps after Mr. Fay's patent. Fig. 3 ex- 
hibits a pair of curved forceps seizing a large molar and excising 
it in the direction indicated upon the tooth. Figs. 4 and 5 
represent the tooth excised. We observe upon the internal 
part of the crown the cavity that contained the dental pulp. 
The surface of the remaining portion of the tooth will not 
present a sufficient cavity to allow of the continuation of the 
decay, and it will be so flat that saliva and particles of food 
will not be retained here any more than upon the crowns of 
any of the teeth. This operation has been approved of, by 
several intelligent English surgeons, who expressed their ap- 
probation of this mode of treatment in the London journals 
in 1826. 

Mr. Fay in such cases, has recourse to excision. We have 
had occasion to examine his improved forceps, and we are con- 
vinced that this operation can be performed without pain. The 
basis upon which we found this assertion is, that in a thousand 
cases we meet with nine hundred and ninety-nine, in which 
disease has not its seat in the roots of the teeth, but in their 
crowns. It is therefore only necessary to remove the diseased 
part in order to give immediate relief Daily experience con- 
firms this truth. A new bony deposition takes place and pro- 
tects the tooth from external injury. The cheeks do not sink in 
as after the extraction of the teeth, and the roots which remain 
will serve as a base for artificial pieces. Mr. Fay's mode 
simply consists in removing with the excising forceps the 
crown of the diseased tooth. No evil consequences will result 
from this J whereas, were the tooth filed, as many dentists 



HYGIENE AND THERAPEUTICS. 



165 



would dOj it would always occasion acute inflammation and other 
evils not less serious. We may add that, were the root of a 
tooth found to be diseased, Mr. Fay by his ingenious mode 
would excise it with as much facility as he does the crown, 
(Extracted from the Globe and the Traveller.) 

A higher encomium upon Mr. Fay^s mode of operating could 
hardly be given than the foregoing ; but it is not enough that 
it should be eulogized by the journals ; it should receive the 
approbation of the dental profession. It has not obtained this, 
however. Most of the reputable dentists of London disapprove 
of it, because, as they assert, the dental nerve not being entirely 
destroyed in the operation, the least heat or cold suffices to 
produce acute pain. They eyen pretend that Mr. Fay himself, 
in excising teeth, has often occasioned injuries; and they not 
only allege that the operation is extremely difficult to perform 
when we desire to excise the tooth at the commencement of 
its roots, but they regard it in all cases as being oftener injuri- 
ous than useful. 

We do not agree altogether with the English dentists on 
this subject. We think, on the contrary, that it is a good means 
of avoiding the extraction of teeth. Of twenty cases that may 
appear to require this last operation, at least one half of that 
number will admit of the former practice without danger, pro- 
vided that it be not performed upon subjects under the age of 
twenty, as after this period of life the dental canal has so con- 
tracted as to leave but a small opening after excision. This 
may be seen in Plate IV. Fig. 4, which represents a tooth of a 
child twelve years old. We here perceive a cavity, very large 
and deep, in which the dental nerve existed. By the side of 
this, (Figure 7,) may be seen the drawing of a tooth taken from 
a subject forty years old. Its cavity is almost obliterated. In 
the latter case the practice here inculcated might have been 
pursued with success, while none could have been hoped for 
in the former. We have performed the operation several 
times, and always with success; but we only attempt it upon 
such persons as confide in us, and who know the advantage to 
be derived from such practice. 

Before terminating this chapter, we will speak of another 



166 



maury's dental art. 



method of avoiding the extraction of the teeth, and which has 
been proposed by M. L. Fattori, which is found in the -Revue 
Medicale. " This method is based upon the following princi- 
ple, namely, that whatever be the cause of pain, it will cease 
when we divide the nerve that supplies the part with sensi- • 
bility, or by any other means suspend its functions. Hence 
to destroy toothache we should discover means by which we 
may sever the dental nerve at the point where it enters the root 
of the tooth. This is what M. L. Fattori has succeeded in 
doing by means of a trepan, with the point of which he cuts 
the dental nerve. This surgeon, having for a long time given 
this subject his whole attention, and having examined a great 
number of teeth, became competent to determine in a majority 
of cases the precise location of each dental ramification; and 
by means of needles of various lengths and sizes, adapted 
to his trepan, he cuts the nerve after having perforated very 
speedily and without pain the diseased tooth, which, by this 
operation, becomes insensible. 

If it should chance to happen that the pain is not relieved 
by this operation, on account of the needle not coming in con- 
tact with the nerve, which it is known often varies its direc- 
tion, he then has recourse to a second operation, in which he 
always succeeds.'^ 

The idea of dividing the dental nerve at the point' where it 
enters the tooth, is certainly very ingenious, and we congra- 
tulate M. Fattori on pointing out so novel a method of curing 
odontalgia. This operation, however, appears to us difficult to 
be put in practice; but if we add to this plan all of the modi- 
fications of which it is susceptible, it will, we doubt not, sup- 
plant the operation proposed by Mr. Fay. We may indeed 
not be far from a period when extraction of the teeth, like 
many other operations, will be but seldom resorted to. 

Our remarks upon the various instruments used for extract- 
ing teeth, and the proposed substitutes for this operation, here 
close. It would have been easy for us to diminish the number 
of these instruments, as experience shows that with our im- 
proved key we can, under all circumstances, perform this ope- 
ration. But, as in many cases, the other instruments spoken 



HYGIENE AND THERAPEUTICS. 



167 



of, are more easily applied, we have thought it proper to de- 
scribe them.* 

* We would here remark — 

First, that the key is less used at the present time than it was at the period 
when this work was written; indeed there are many dentists of high reputa- 
tion who have discarded its use altogether. 

Secondly, that the improvements made in the construction of the various 
kinds of forceps used are such, as in our opinion, to enable the dentist to per- 
form all operations with them, that the key would enable him to do, with 
greater certainty, and less likelihood of the occurrence of unpleasant ac- 
cidents. 

Thirdly, that the practice of excision, recommended in the text, is at all 
times unsafe, and will, in many instances, if pursued, be attended with painful, 
and even fatal consequences. There are cases, it is true, where a tooth has 
been accidentally broken off, in which we would permit the root to remain 
as a support for the adjacent teeth; but these cases are so rare, that we would 
regard the wilful excision of the crown of a tooth as a barbarous operation, 
unless it be a superior incisor or cuspidatus on which it is designed to place 
a crown by means of a pivot. 

These remarks will apply to the author's entire treatise on the instruments 
used for extracting teeth. We would here add a description of some of the 
forceps most generally approved of, but that they are so various, and in 
many instances their differences are so minute, that our prescribed limits will 
not admit of it. 

For the extraction of the superior molares, however, we think the forceps 
recommended by Mr. Snell are certainly superior to any in use. We will 
give a description of them in his own words. " For the upper molares, a 
strong pair of forceps is required, just sufficiently curved to keep the handle 
free from the lower teeth. The practicien should be provided with two 
pairs, one for each side; the termination of the inner chop should be in a fiat 
groove, similar to the shape of the tooth on that side, which, it will be re- 
membered, is the side where the single large fang is situated. The outer 
chop should terminate in two grooves, with a fine point in the centre, which 
point should be carefully introduced, as nearly as possible, between the two 
fangs, which are situated on the outer side. The convenience of two pairs 
of forceps is evident, as each pair would be especially adapted to one side. 
The tooth having been firmly grasped with a pair of these forceps placed 
sufficiently high, and having been pressed firmly outwards and inwards, may 
be removed with the greatest facility." 

" The molares of the lower jaw require two pairs of forceps, one for each 
side, on account of the hook to turn around the little finger, which, it will 
be evident, must be on opposite sides of the instrument, for the opposite sides 
of the mouth. These forceps should be strong, with beaks short, and termi- 
nated by a double groove, with a fine point in the centre of each, so situated 
that as the lower molar teeth have two fangs only, the two points may be 
introduced between them." The handles of the lower molar forceps have 
been so constructed as to obviate the necessity of having two pairs. — S. 



168 



maury's dental art. 



PRECAUTIONS AFTER THE EXTRACTION OF TEETH. 

Whatever instrument may be used in the extraction of a 
tooth, there are certain precautions proper to be observed after 
the operation. The dentist should, for example, before per- 
mitting his patient to rinse his mouth, allow the blood to run 
for a few moments, or favour the discharge of blood by the use 
of tepid water; and only advise tonic and acidulated lotions 
when it continues to flow several hours after. 

It is not necessary to approximate the gum with the fingers 
unless we think that it has been widely lacerated, or that a 
portion of the alveolar process has been splintered. In the 
latter case, the splinters should be removed with the fingers, 
or with a small pair of dressing forceps. 

The patient should be advised to cover his mouth, or to 
avoid exposure to the cool air for several days. A healing 
lotion may be used with propriety during this period. The 
patient should also be cautioned against sucking the gum, as 
this may occasion a second hemorrhage. By paying strict 
attention to this advice, complete success will always attend us 
in our operations. 

THE ACCIDENTS THAT MAY RESULT FROM THE EXTRACTION OP 

TEETH. 

In spite of the utmost skill and care on the part of the den- 
tist, serious accidents will sometimes occur in the extraction 
of teeth; but these may generally be remedied. 

They affect the general organization at times, either before 
or after the operation, producing pain, convulsions, &c.; and at 
other times lesions of the adjacent parts are occasioned, as — 
1. rupture or laceration of the gum ; 2. fracture of the alveolar 
process; 3. hemorrhages arising from lesions of the part; 
4. luxation and fracture of the jaw; 5. fracture of the tooth to 
be extracted, or some of the neighbouring teeth ; 6. loosening 
of the adjacent teeth ; 7. complete extraction of these last. 
The affections first alluded to here, affecting the general orga- 



HYGIENE AND THERAPEUTICS. 



169 



nization, are altogether beyond the control of the operator's 
will ; but those of the second class are, in most cases, the result 
of defective instruments, or the unskilfulness of the dentist. 
We shall examine some of these accidents in particular, and 
ascertain in what manner they may be repaired. 

Pain of the Teeth after Extraction^ and attendant Evils, 

The pain produced by extraction of the teeth is usually 
very acute, but it is of brief duration. We sometimes, how- 
ever, see persons who experience pain for a long time after 
this operation; and, as we have already observed, derangement 
of the whole physical economy is attendant upon it. Some 
indeed faint away after the operation; and others, especially 
women,, whose nervous systems are feeble, experience univer- 
sal trepidation, and attacks of epilepsy, as we have had occasion 
to witness in the course of our practice. A species of tetanus 
is sometimes, though rarely, produced. Involuntary w^eeping 
is also produced. This resulting from a shock imparted to 
the eye by the rupture of the dental nerve, which also commu- 
nicates to that organ. We have even known suppression of 
the catamenial discharges, and miscarriage, to proceed from 
the extraction of a tooth when performed without the full con- 
currence of the patient. 

We are far from pretending that it is in the power of the 
dentist to avert all tlie disasters we have enumerated. This is 
impossible. But, by his address, he may ameliorate their 
severity. He should be an adequate physiognomist to per- 
ceive, at a glance, the physical and moral condition of his pa- 
tient; and he should be prudent enough to avoid proceeding 
with the operation, unless convinced that he can effect it with- 
out injury. Bland and persuasive manners are also worthy of 
being cultivated by the dental practicien. 

Contusions and Lacerations of the Gums. 

Contusion of the gums is generally produced by pressure 
upon them with the key, or some instrument used in like 
manner. Laceration of the gums is generally produced by 
15 



170 



maurt's dental art. 



fracture of the alveolar process. It seldom occasions serious 
consequences; but has at times been known to give rise to 
inflammation of a very alarming character, which all possible 
means should be resorted to in order to subdue. Considerable 
hemorrhage may also be produced by this accident, but can be 
generally checked by the use of acidulated and spirituous gar- 
gles, which should be persevered in as long as the case may 
require. 

• 

Fracture of the alveolar Process. 

It often happens, when a tooth is unskilfully extracted, 
that a portion of the alveolar process is brought away with it. 
The danger of the occurrence of this accident also depends 
upon several circumstances, as the adhesion of the tooth to its 
socket by its periosteum, the thickness of the parietes, the 
length, number, curvature and divergence of the roots, &c. 
When, however, such accident has occurred, we should en- 
deavour to detach the splinters that may adhere to the tooth 
before showing it to the patient, as no good can result from 
such exhibition, but alarm or disapprobation rhay be excited. 
If this cannot be done, it will be well to apprize the pa- 
tient of the accident, and by means of pressure we should 
arrest whatever hemorrhage may ensue. By means of emol- 
lients, the inflammation that may occur may then be remedied; 
and the same means will also cause the inflammation to termi- 
nate in resolution. 

Hemorrhage. 

Hemorrhage is one of the most serious accidents that may 
result from the extraction of teeth. It usually occurs in con- 
sequence of the accidents we have already mentioned. It may 
also, unavoidably, result from the size, situation, and peculiar 
form of the tooth, the tendency of the vessels of the part, the 
habit tliat many persons have of sucking the gum, exhaustion 
after extraction of the tooth, scorbutic diathesis, &c. 

This result does not always manifest itself at the moment of 
the operation, but hours, and even days after. It then occurs 



HYGIENE AND THERAPEUTICS. 



171 



in consequence of the disturbance of the coagulum in the alveo- 
ius, or because of irritation by means of some mechanical agent, 
ere the mouths of the vessels have adhered. 

When a tooth is properly extracted, the discharge of blood 
that takes place is usually spontaneously arrested. It may 
even be imprudent to suppress it, as it contributes to prevent 
inflammation. It may, however, happen that hemorrhage, very 
slight in appearance, may continue so long, or be so often re- 
peated, as to become dangerous. We should then hasten to 
relieve it by the customary remedies; but these sometimes 
fail. 

In simple cases, the discharge from the gums may be arrested 
by the use of gargles slightly acidulated, pediluvia, and by 
a mild regimen. 

If the hemorrhage be obstinate, and resist the remedies above 
indicated, after having removed the splints adhering to the 
gums, we should apply to the wound a piece of white or yellow 
wax, softened, and direct the patient to close his jaws forcibly, 
and maintain it in this position for a number of hours. A 
bandage carried beneath the inferior jaw, and upward over the 
head, will here be of advantage to prevent the mouth from 
opening involuntarily. Some practiciens use at times, to arrest 
these hemorrhages, pledgets of cotton saturated with acidulated 
water; at other times pieces of tinder or powdered agaric, 
resin or gum Arabic powdered finely. 

We may, in extreme cases, resort to either the potential of 
actual cautery; but these means require much circumspection, 
are productive of pain, do not always effect the desired object, 
and always alarm the patient. We would prefer the applica- 
tion of the wax, as above indicated.* 

* " Excessive hemorrhage from the extraction of a tooth does not appear to 
be dependent upon the manner in which a tooth is extracted, but seems 
rather to be attributable to constitutional temperament. Hence, whenever a 
tendency to it exhibits itself in one member of a family it is usually 
found to exist in all." (Harris's Dental Jlrt.) Dr. Harris uses for the sup- 
pression of such hemorrhage pledgets of cotton or sponge saturated with the 
tincture of gall nuts; but, he remarks, " pressure, after all, is the only thing 
on which we can rely." If it be so applied as to act directly on the mouths 
the bleeding vessels, it will be found to be more efficacious than the mosj; 
P&werful stiptic, or any other remedy to which we can resort.^ — S. 



172 



maury's dental art. 



Before dismissing this subject, we would remark upon he- 
morrhage occurring after the extraction of a tooth in a subject 
of a scorbutic diathesis. It is a fearful affection, and frequent 
returns of it may well be apprehended. In defiance of the 
most efficient means that are known, it may terminate fatally. 
Under such circumstances, as in the preceding cases, we should 
fill up the cavity, and keep the jaws of the patient closed by 
means of a bandage. 

Rupture of the maxillary Sinus, Fracture of the alveolar Arches^ 
and Luxation of the Jaw. 

Surgeons and dentists have been known to fracture the walls 
of the maxillary sinus, to bring away a part of one or both of 
the alveolar arches, fracture the jaw, and sometimes occasion its 
luxation, by pressing the instrument too firmly upon the infe- 
rior jaw. These accidents, fortunately, are very unfrequent. 
M. Duval relates several examples of this kind. When we 
were in Calais, in 1815, we treated a case of this kind. The 
patient was a labouring man, and had the inferior jaw fractured 
by means of a key having a straight shaft. It was in conse- 
quence of observing this accident, and from having seen a short 
time previous in the possession of Mr. Fox of London a key 
of this kind somewhat varied in its construction, that we were 
induced to make some alteration in the key of Garengeot. 
The tooth in the case we speak of had been extracted with the 
fulcrum of the instrument upon the palatine side of the arch, 
and the surgeon, on account of the construction of the shaft of 
the instrument, had to rest an angle of this fulcrum upon a 
neighbouring tooth, and in consequence the tooth was broken 
and the jaw fractured. The accident had occurred nine months 
previously to our seeing the patient, whose condition, on exami- 
nation, we considered very alarming. We discovered a con- 
siderable fracture of the inferior maxilla on the right side. 
This fracture had necessarily been occasioned at the time of the 
extraction of the tooth. A portion of bone, extending from 
the angle of the jaw to the cuspidatus tooth, and to which 
several teeth were still adhering, was necrosed, and, acting as 
a foreign body, it occasioned a continual mechanical irritation. 



HYGIENE AND THERAPEUTICS. 



173 



rhis increased the fistulous openings, which were numerous, 
and exhibited several splints. A piece of bone, terminating in 
a point, and about one inch and three lines in length, and eight 
lines in width, (PI. XIII. Fig. 1,) rested upon the external part 
of the cuspidatus. 

Such was the situation of the patient when we proposed the 
removal of this bone. He willingly acceded to it, and after we 
had cautiously detached from the principal sequester a large part 
that was adhering to it, we with some difficulty removed it. 

The remaining portion of this bone, about an inch and nine 
lines in length, and about eight lines in width, and occupying, 
like the first part, the right side of the jaw, and from which the 
teeth had been detached, was in a few days after removed, 
with greater facility than the first. 

The irritation and inflammation ceased from that time; the 
fistules cicatrized in from fifteen to twenty daj's; mastication 
becoming easier, digestion was re-established; and in about 
three weeks the patient was entirely cured. 

At the time of our last journey to England, we had occasion 
to see the person who was the subject of this operation; he 
was but slightly disfigured, although he had lost a greater por- 
tion of the right side of the maxillary bone, and although the 
cuspidatus antagonized with the superior second molar of that 
side. We took an exact impression of both jaws of this per- 
son, and formed articulating moulds from them. 

It should not be concluded from this particular case, that it 
is always proper to remove the portion of bone fractured from 
the jaw. Such conduct, under circumstances differing from 
those that we have related, might be improper. If the fracture 
in this case had been recent, it would have been better to en- 
deavour to .effect a reunion, and only have recourse to the re- 
moval of the osseous fragments when our efforts had failed. 
Cases of this kind, however, are seldom met with in practice. 

Luxation of the Jaw is not always owing to imprudence on 
the part of the operator: it may arise from a peculiar disposi- 
tion of the articulating surfaces. But, whatever may be the 
cause, it should be immediately reduced, and the consecutive 
injuries should be relieved by all possible means. 

15* 



174 



maurt's dental art. 



In order to reduce a luxation of the jaw, the thumb, enve- 
loped in a piece of linen, should be placed within the mouth, 
and with the fingers under the chin, we seize the jaw. Press- 
ing near the condyle with the thumb, and raising the chin at 
the same moment, we bring it into its place. The other hand 
is at the same time pressed upon the forehead. 

Loosening, Fracture, and complete Extraction of the Teeth. 

Loosening of the Teeth.— The loosening of the teeth adjoin- 
ing that we are about to extract may be occasioned as often 
from the confusion that the patient causes, by his alarm at the 
apparition of the instrument, and thus occasioning its derange- 
ment after it has been properly applied, as from the improper 
manner in which it is used. 

Under such circumstances we should allow the loosened teeth 
to remain, redress those that have been luxated, and maintain 
them in their places by ligatures as we would a single luxated 
tooth. 

Fracture of the Teeth. — The molares are sometimes so solid- 
ly implanted in their sockets, and adhere to them so strongly, 
that it often happens that we break them in the attempt to 
extract them. The instrument is sometimes broken, though 
this is uncommon. This accident is not always occasioned by 
the sudden motion of the hand, as is usually supposed: it may 
be occasioned by various other causes. Fracture of a tooth 
may sometimes be unavoidable from its extreme brittleness, 
or from its being extensively decayed; sometimes from the 
disposition of its roots, which may be strong, crooked, diver- 
gent, convergent, or nearly united at some point to the socket; 
and sometimes, as in the loosening of teeth, by the patient 
grasping the hand of the operator. 

If the fractured portion is not deep in the socket, and we 
can yet seize it, we should attempt its extraction; or should it 
not be loosened, by destroying its asperities with a pair of for- 
ceps, and smoothing its surface with a file, it may be sufiered 
to remain. If it be very deep in the socket, we should not 
disturb it, as its extraction may cause the patient pain, and its 
presence may not prove inconvenient. It is even well to pre- 



HYGIENE AND THERAPEUTICS. 175 

serve themj for the dental nerve and pulp being destroyed, 
there is no sensibility in them, and they will continue to main- 
tain the neighbouring teeth in their sockets, and in old age they 
will prove useful in mastication. 

We deem it proper here to remark, that before operating 
upon teeth that present prominent points upon the alveolar 
border, and the crowns of wliich are short and thick, too much 
care cannot be taken by the practicien, as such teeth are often 
removed with great difficulty. 

Accidental Extraction of one or more Teeth. — Sometimes in 
attempting to extract one tooth, we extract two which are 
found to be united. (PI. VIII. Figs. 4, 7.) An accident of 
this kind cannot be ascribed to the unskilfulness nor awkward- 
ness of the operator: but to extract a sound tooth through mis- 
take or a permanent for a deciduous tooth, is indicative of the 
grossest ignorance.* 

The only means of repairing so gross an error is immediate- 
ly to replace the tooth or teeth thus extracted, and to resort to 
the use of ligatures. We can furnish numerous examples that 
have occurred in our practice of teeth that, having been removed 
either by a blow or fall, or by the awkwardness of a dentist, 
and that were again placed in their sockets, and became as firm 
as ever. This operation is somewhat analogous to that of 
transplanting teeth, of which we shall now speak. 

Transplanting Teeth. — This operation, practised in Paris 

* We cannot refrain from remarking here, that of the many accidents de- 
scribed by our author but few could occur from the use of properly constructed 
forceps. A review of them indeed will not be without profit to one who 
would listen to evidence in deciding upon the description of instruments he 
would adopt the use of in practice. For ourselves there is but one considera- 
tion that induces us to pay any degree of deference to the recommendations 
of the extracting key: it is that there are some dentists of eminence who still 
use it, and who contend that it is not only a good and safe instrument, but 
that it is superior to the instruments of more recent invention. We would, 
however, suggest, and with deference, whether the ease and certainty in its 
application, acquired by years of familiar practice be not in reality the grounds 
of such preferences.' Mr. Snell remarks on this subject that " considerable 
differences of opinion exist, and probably will continue to exist as to which 
are the best instruments ; each operator feeling a preference for that with 
which he has been accustomed to operate successfully." — JS. 



176 



maury's dental art. 



about two centuries ago by a surgeon, consists in extracting a 
tooth from the mouth of a young and healthy person to be 
inserted in the freshly opened alveolus of another person, 
who has been obliged to submit to the extraction of a tooth 
of the same class. 

This dental prothesis, which still unfortunately enjoys some 
reputation in England and Germany, is almost entirely aban- 
doned in this country. It is a cruel practice, disapproved of 
by every sentiment of humanity, and should be discarded from 
French surgery. In 1812, while young in the practice of 
dental surgery, we performed this operation in two cases, the 
subjects being about eighteen or twenty years of age. We 
transcribe verbatim, two letters, written to us since that period. 
The details they contain will give us a correct idea of the ad- 
vantages we may hope to obtain from this operation of trans- 
planting teeth. 

Vie, October 15, 1825. 

Monsieur: 

I have received your letter addressed to Mademoiselle de C * * *, now mj 
wife, and 1 hasten to reply to it in conformity to your wish. 

The tooth that you inserted for her in 1812 never became firm, and eight 
or ten months after that time she removed it. It did not retain its colour. 
You will doubtless recollect that you were obliged to file its root two or three 
times, and its never having become solid may perhaps be attributable to this. 
It occasioned no inflammation. With respect, yours, R * * *. 

Vie, December 20, 1826. 

Monsieur: 

In conformity with your desire I hasten to inform you that the tooth you 
inserted for me in 1812 still remains in its socket, but has never been firmly 
seated, and I think it will finally fall out. The part of the gum that covered 
its root began to recede three or four years since. At present the root ia 
entirely exposed. The tooth has not preserved its colour. 

I have the honour, &c. S. L * * *. 

P. S. I omitted to inform you that this tooth has never been the occasijon 
of pain, 



PART III. 
MECHANICAL DENTISTRY. 



PART III. 



MECHANICAL DENTISTRY, OR ODONTOTECHNY, AND THE ME- 
CHANICAL MEANS OF REMEDYING LESIONS OF THE PALATINE 
ARCH. 

General Considerations upon artificial Teeth 

In the preceding chapters we indicated the resources pre- 
sented by the dental art to remedy the diseases of the teeth, 
and pointed out the various means of extracting them when 
their preservation becomes impracticable. It now remains for 
us to examine the various means of replacing teeth that have 
been lost, and the materials of which these are manufactured. 
This part of our art has been called denial prothesis. 

We shall not here enter into a detail of the antiquity and 
origin of this prothesis; but will recommend the reader for 
this to the learned pamphlet of M. Duval which bears the 
following title: Conseils des Pontes Amiens sur la Conservation 
des Dents. We will merely say, that the polished people of 
antiquity paid particular attention at all times to their teeth, 
and endeavoured to repair their loss by mechanical means. 

We see, indeed, by the writings of travellers, that the Chi- 
nese, Indians, certain colonies of America, Africa, Asia, &c., 
in compliance with ideas more or less capricious, cut their 
teeth in various ways with flints. It is also known that the 
people of the colonies inhabiting New Zealand and New 
Holland shape their teeth in such a perfect manner that they 
appear to have been operated upon with a file. W e have made 
(PI. XVI. Figs. 3, 4, 5, 6,) several drawings from the natu- 
ral pieces and designs furnished us by Dr. Busseuil. 

Whatever may be the origin of odontotechny, it is certain 
that this branch is carried to a greater degree of excellence at 



180 



maury's dental art. 



the present day than it ever attained in former times, parti- 
cularly in our country, where this department of dentistry has 
become so good and so general as to be considered as an art, 
the many advantages of which all classes of society have felt. 

It was Fauchard, our tutor, who first, in 1728, gave a treatise 
upon the JMoyeiis de Remplacer les Dents et de Remedier aux 
Vices de Conformation de la Voute Palatine. Several French 
and foreign works have appeared since that time, and although 
incomplete, they furnish valuable information upon the sub- 
ject now before us. They appear to us to be susceptible of 
important additions, and if we cannot flatter ourselves that 
w^e can furnish a perfect treatise upon this part of the science, 
we at least hope to point out the various improvements that 
have been recently introduced, not only in dental prothesis, 
but also in the various ways of applying incorruptible teeth. 

ARTIFICIAL TEETH. 

We designate as artificial teethe teeth destined to replace such 
as have been lost by some cause. When these teeth are pro- 
perly constructed, and when rightly adjusted and maintained 
in the mouth, they possess all the advantages of the natural 
teeth, as well as ornaments of the mouth, as for the purposes 
of pronunciation or mastication. They completely remedy 
the great inconvenience resulting from the discharge of a part 
of the saliva from the anterior part of the mouth, occasioned 
by the loss of the anterior teeth. 

When artificial teeth are well adjusted, they often contribute 
to the solidity of the dental arch, particularly in the mouths 
of persons whose teeth are long, and whose gums are liable to 
be chafed by them. In this case a support is afibrded them 
which ensures their solidity; but there are certain conditions 
a compliance with which is required, that these may fulfil the 
end desired. 

They should as nearly as possible resemble in form and co- 
lour the lost teeth. Their retention should not depend upon 
the adjacent teeth in such manner as to impair them. 

It is important that artificial teeth should be preserved in 



MECHANICAL DENTISTRY. 



181 



perfect cleanliness; they should be cleaned as often, or oftener, 
than the natural teeth require to be. 

The materials that have been used in constructing artificial 
teeth are the bones and the teeth of oxen, horse, sheep, stag, 
and several other animals; ivory, mother-of-pearl, teeth of the 
hippopotamus or sea-horse, of the whale, human teeth, incor- 
ruptible teeth made of mineral paste. Persons who have been 
deprived of their front teeth, have, for a long time, replaced 
them with artificial teeth made of white wax. 

We shall briefly examine these various substances, the 
number of which have been greatly reduced. We would, 
however, here remark, that the teeth of the hippopotamus, the 
human, and the incorruptible teeth, are most generally used at 
the present time. 

Bones of the Ox. — These bones, being entirely destitute of 
enamel, bear but little resemblance to the natural teeth, and are 
very porous: they become yellow, and decompose very soon. 
They have, however, for a long time been used for fabricating 
supports or bases resembling the gums. For this purpose the 
femor has been used, after having been cleansed in clay and ex- 
posed to the dew to whiten. 

Teeth of Oxen, Horses, <^c. — As we cannot give these the 
shape of the human teeth by means of the file, it is easy to de- 
tect them otherwise than by the absence of the enamel, which 
does not cover the surface of these teeth. Their colour does 
not resemble that of the human teeth. If, however, we are 
obliged to use them from the want of human teeth, we should 
choose those of animals advanced in age, because of their central 
cavity being smaller than at a younger period of life; they are 
hence more solid, and better adapted for the reception of 
pivots, by which they are to be attached to the artificial base. 

Ivory. — Sometimes parts of sets, and sometimes complete 
dentures, are manufactured of this substance; but, like the 
preceding, it is not a good imitation of the natural organ. 
Ivory, being void of enamel, becomes yellow very soon in the 
mouth, and the saliva and mucus decompose it, after a time, 
in spite of the care that may be taken. (PI. XVII. Fig. 21.) 
16 



182 



maury's dental art. 



In case we cannot procure a substance more resisting, as the 
tooth of the sea-horse, we should prefer the ivory of young 
elephants, and the central part of the tooth near the point. 
The grain at this point is more compact, and the ivory usually 
lasts longer than that of any other part of the tooth. Green 
ivory, that is, ivory taken from the teeth of animals that have 
been recently killed, is preferable. 

Mother of Pearl. — Wis need merely name this material. It 
is unfit to be used for this purpose, and has been seldom em- 
ployed. 

Hippopotamus, -^The use of the tooth of the hippopotamus in 
manufacturing teeth, is of recent date, as ivory was, for a time, 
almost exclusively used; but the inconveniences of the latter, 
already named, and the superiority of the sea-horse tooth, have 
induced dentists to abandon the use of ivory. At the present 
day the tooth of the hippopotamus is much used, both with 
and without the enamel. 

These teeth are obtained in commerce from Africa, and the 
most distant parts of Asia. Such as are least hollowed out are 
considered best, as their ivory is more compact than those that 
are hollow. These teeth vary much in size, colour, form and 
enamel. - 

The incisores of the hippopotamus are short, semi-cylindri- 
cal anteriorly, contain a deep furrow, and are enveloped with 
enamel, the colour of which, when polished, resembles that of 
the human teeth. Their semi-circular form enables us to carve 
from the same piece several teeth having enamel upon them. 
They sometimes contain deep furrows, by which we are ena- 
bled to carve six or eight teeth thus shielded with this sub- 
stance. 

The tusks of this animal are larger and longer than the inci- 
sores, and are curved like those of the wild boar. Their least 
weight is two pounds and a half. They sometimes weigh 
nine pounds, but this is uncommon. The teeth are flattened 
posteriorly, and convex anteriorly, and are covered with ena- 
mel only on the latter side. Their size enables us to form 
complete dentures of them, not enamelled, or bases upon which 
enamelled teeth are afterward to be attached. 



MECHANICAL DENTISTRT. 



183 



We should make use of such as have their internal substance 
compact, white and smooth. The best are white, round, ena- 
melled at their smallest part, and have not large ridges or deep 
depressions, and are not cracked in the direction of their cur- 
vature. To preserve them they should be kept in a humid 
place. When using them or working them, we should be care- 
ful not to expose them to the sun, fire, or current of air, as 
such exposure will tend to crack them, especially in such 
places as are not protected by the enamel. 

If we cut a hippopotamus' tooth transversely through its 
middle, we will perceive a furrow, whose depth depends en- 
tirely upon the age of the animal. We should as much as 
possible avoid this furrow in manufa-eturing pieces. If its use 
cannot be avoided, the piece should be so constructed that thk 
defect may not be perceptible, as this part is yellow, and mor^ 
easily acted upon by the secretions of the moutii. 

However perfect and beautiful may be the piece of this ma- 
terial used, its extreme whiteness, which at first pleases the 
eye, sooner or later is lost, and a bluish or yellow hue is 
assumed. 

Artificial bases are generally made ^f the tooth of tlie sea- 
horse, and human teeth are inserted into this; and when these 
bases are neatly carved and polished, they present a very good 
appearance. 

The incisorcs of the inferior jaw of the hippopotamus are 
called, improperly, in commerce, the teeth of the sea-cow. 
These teeth are round, and have no enamel, and when they are 
of a proper size, complete denUires are manafacttired out of a 
single piece by its being cut lengthwise. 

Teelh of the Whale. — These teeth are sometimes in com- 
merce mixed with those of the sea-horse. They are as strong 
as the latter, but differ very much from them in form, and in 
their durability. They may, however, be used in the manu- 
facture of the bases when we cannot procure a substance more 
compact. 

Human Teelk — Of the various articles used in replacing the 
lost organs, the human teeth, without doubt, merit the prefe- 



184 



maury's dental art. 



rence, since they are such as were given us by nature. We 
shall indicate the manner in which they should be chosen, and 
the various preparations they should undergo before insertion. 

These teeth are generally obtained from the mouths of per- 
sons who die in hospitals, and whose bodies are brought into 
the amphitheatre for dissection. The best are such as are not 
decayed or cracked, and have been taken from subjects between 
the ages of eighteen and forty years. The teeth at this time 
of life are firm and of the most desirable consistency, and are 
capable, for a long time, of resisting the destructive agents to 
which they are constantly exposed. The teeth of younger 
subjects are too tender, their canal is too large, and they are 
incapable of resisting deleterious influences. Those of old 
men are hard, but yellow and much worn, and crack very 
easily. We should prefer the teeth of adults which have been 
recently taken from the subjects. We should reject all such 
as are not entirely sound, or the cavities of which are red or 
black, as they very soon become black in the mouth and decay. 
It is true, that if a cavity be found upon the side of a tooth used 
for this purpose, we may drill the decay out, and insert a plug 
made of the tooth of the hippopotamus; but these should not 
be used if sound ones can be procured. 

The teeth being chosen, we should preserve them in such 
manner as to be able to use them at any moment. They should 
be extracted from the subject with care, and portions of the 
alveolar process, periosteum, gum, or tartar, that may adhere 
to them, should be removed. The extremities of tlieir roots 
should be pierced, and they should be strung in the order in 
which they had been placed in the mouth. They should then 
be steeped for seven or eight days in water, which should be 
changed every twenty-four hours. At the expiration of this 
time, they should be again cleaned by being rubbed with a 
piece of soft wood, as willow or nr, wet and dipped in pow- 
dered pumice stone. In this manner we can remove all foreign 
bodies from the teeth. If there should remain any stain or 
spot, it should be removed with the file or grindstone. They 
are next to be washed with soap and water, and the process of 
cleaning is to be concluded by immersing them in alcohol. 

We generally use the eight superior teeth, viz: four inei- 



MECHANICAL DENTISTKY. 



185 



sores, two cuspidati and two anterior bicuspides. It will be well, 
however, to procure the eight corresponding inferior teeth, as 
they are sometimes required, ' 

The teeth, being thus cleansed and assorted, should be placed 
in a vase and covered with sand, bran, fine grain, saw-dust, or 
any thing capable of excluding the air, heat, and cold. 

Some dentists preserve them in water or diluted alcohol. 
This is a bad practice, as they become yellow and crack after- 
ward when exposed to the air. Others preserve them in equal 
parts of wax, chalk and oil; but this is inferior to the simple 
mode we have already recommended. When we cannot pro- 
cure the eight teeth from the same individual, care should be 
taken to select such as harmonize well together. We should 
be cautious in using teeth that have been procured from ceme- 
teries; for, after having remained in the earth for a time, their 
enamel is apt to be dull. Their bony substance, also, is likely 
to be yellow, or of a brown hue, which is the result of decom- 
position. While preparing teeth of this kind, they often break 
very easily, and when inserted soon become black and decay. 

When we wish to insert two or three of these teeth, we 
adjust them upon a platina or gold plate, if the alveolar border 
be not' too much absorbed. If this be the case they should be 
mounted upon a sea-horse base, and secured to it by means of 
platina rivets. 

Animal substances of which artificial teeth are made possess 
the inconvenience of being liable to a speedy softening and 
decomposition; and they tarnish and emit a disagreeable odour. 
We are therefore obliged to renew them frequently. To ob- 
viate this inconvenience, it has been proposed to manufacture 
artificial teeth of earth, capable of being hardened by means 
of heat, and enamelled like porcelain. These teeth are called 
incorruptible. 

Incorruptible Teeth. — M. Duchateau, apothecary at St. Ger- 
maine, in Laye, in 1774, first imagined the construction of por- 
celain teeth resembling those of ivory that he wore, and from 
which he had experienced much inconvenience; and for this 
purpose applied to the porcelain manufacturers of Guerhard in 
Paris. But the first attempts made by these were unavailing, 

16* 



186 



maury's dental art. 



on account of the contraction of the material in the process of 
baking. This difficulty induced M. Duchateau to use fine 
porcelain, which vitrifies in a heat of from thirty to thirty-five 
degrees, according to the pyrometer of Wedgwood. (The hard 
porcelain now used must be submitted to a heat of one hundred 
and thirty to one hundred and forty degrees, according to the 
same pyrometer.) In order to obtain complete success in the 
trial of the pastes, and in the mode of application of the teeth, 
he consulted several distinguished artists, and also M. de Che- 
mant, at that time dentist in Paris. These artists gave advice 
relating to the mode of manufacturing porcelain teeth; and 
M. de Chemant directed their mode of application. To the 
paste first used was now added colouring earths, which rendered 
it more fusible, and susceptible of being baked in a simple 
muffle. After several unsuccessful attempts he at length com- 
pleted a piece of a grayish white colour, and which had shrunk 
very little. These he adapted to the alveolar border. Sa- 
tisfied with his experiment, M. Duchateau attempted to exe- 
cute similar dentures for persons of quality; but, being wholly- 
unskilled in the dental art, he did not succeed in his enter- 
prise. In 1776 he communicated this discovery to the Royal 
Academy of Surgeons in Paris, and in return received the 
thanks of the Academy and the honour of membership. 

M. de Chemant, having improved this composition by the 
addition of Fontainbleau sand and Alicante soda, chalk, oxyde 
of red iron, and cobalt, manufactured similar teeth. He in- 
serted several of them, and twelve years after obtained from 
Louis XVI. a patent for the invention. Duchateau and others 
disputed the title to this discovery, and entered a protest; but 
they failed of success, as their title was not legal. Hence it 
is to M, Chemant that it is to be attributed, as, but for him, it 
would still be unknown. 

This important discovery has since that time been greatly 
improved, and incorruptible teeth are in general use at the 
present time. 

We have spoken in detail, in the second edition of our 
Manuel du Dentiste, of the perfection to which M. Fonzi has 
brought these teeth. M. Pernet Desforges, and several other den- 
tists, have laboured with great success, and we ourselves have 



MECHANICAL DENTISTRY". 



187 



for the last ten years contributed to their general reputation, 
by inculcating the mode of making and applying them, and 
by selling them to our professional brethren at prime cost. 
The incorruptible teeth now manufactured in Paris resemble 
very closely the natural teeth. Some old practiciens, a number 
of them of reputation, yet universally use human teeth and 
those of the sea-horse ; but we can easily comprehend their 
motive in this: they are already advanced too far in their 
career to deviate: they do not study new discoveries, and the 
use of the new teeth requires great practical knowledge, which 
they will not acquire. 

Wax. — Some persons often remedy the loss of teeth, by 
filling up with a piece of white wax the space that these organs 
had occupied. There can, however, result little advantage 
from this practice, first, because persons who apply this mate- 
rial are obliged to renew it often; secondly, they cannot make 
it so secure as not to be in danger of being lost either in speak- 
ing or eating. These inconveniences are sufiicient to cause 
them to abandon its use. Yet we must confess that we have 
known persons who wore such teeth for many years. 

Upon a review of what we have already said of the various 
kinds of artificial teeth, we will observe — 

1. That we should totally renounce the use of teeth manu- 
factured from mother of pearl, the bones of oxen, ivory and 
wax; 

2. That under certain circumstances we may employ the 
teeth of oxen, sheep, hind, and some other animals, and also 
the enamelled part of the tooth of the hippopotamus; 

3. That the tooth of the hippopotamus is superior to all these 
substances when several teeth are to be made; 

4. That the human teeth, as they are such as are given us 
by nature, are daily used with great success ; 

5. That the improved incorruptible teeth leave us nothing to 
desire, as regards the close imitation of nature, their hardness, 
and their applicability under all circumstances. 

To be sure of our work, it is important in this, as in every 
thing else, that we should perform it ourselves, and to succeed 
we should know the materials used, and be familiar with the 



188 



maury's dental art. 



use of proper tools. Application and some aptness in mecha- 
nism are therefore essential. 

Before proceeding to the exposition of the various means by 
which artificial teeth are retained in their proper places, we 
shall examine the foundation of the objections that have been 
urged to their use. 

It is said that artificial teeth cannot be made to perform the 
principal functions of the natural teeth, which are those of 
mastication, because the various movements of the inferior 
jaw in the comminution of food, by acting against the artifi- 
cial teeth, occasions the loosening of the natural teeth, or the 
roots upon which the artificial teeth are sustained. 

We cannot indeed hope for a substitute for the natural teeth 
as good and complete in all respects as themselves ; but if the 
losses we are unfortunately afiflicted with may thus be partially 
restored, we should be gratified. Should we therefore deny 
the utility of dental prolhesis, because we cannot equal nature 
in the beauty and excellence of her mechanism ? Artificial 
teeth well executed and applied are, however, of great utility, 
nor need we apprehend the results thus anticipated. 

The objection made to the use of animal artificial teeth, that 
they impart an unpleasant odour to the mouth, is only valid in 
cases in which they are inaccurately applied, or in which the 
persons wearing them are neglectful in regard to cleanliness, 
or fail to renew them when decayed. If, however, incorrupti- 
ble teeth be used, no more care is necessary than is required 
by sound natural teeth. 

It is also said that teeth artificially inserted occasion pain, 
and often require to be removed some days after being applied. 
These inconveniences never occur when they are prepared by 
a skilful dentist, and when the gums and roots are in health 
at the time of their insertion. Such condition of these parts 
is a subject requiring close attention. 

It is also said that artificial teeth become loose and fall out 
spontaneously. This is true; but such inconvenience only 
takes place in teeth of bone that have been for a long time 
worn, and when the saliva has entirely destroyed the parts 
surrounding the pivots by which they are retained. The fall- 
ing out of an incorruptible tooth can only occur from an acci- 



MECHANICAL DENTISTRY. 



189 



dent that may break it or detach it from the solder; such an ac- 
cident may also occasion the loss of a natural tooth. 

It is also erroneous to suppose it necessary to take out the 
artificial teeth every night. On the contrary this should never 
be done, for this will wear away the roots, if the teeth be im- 
planted upon them, and hasten the destruction of the natural 
teeth if these be used for supports, as already described. 

In refuting the objections urged to artificial teeth we have 
in some manner already pointed out the advantages resulting 
from their use, and which will be more perceptible if we re- 
flect that these teeth are intended less to masticate solid aliment 
than to remedy a deformity, and an impediment to pronuncia- 
tion resulting from the loss of teeth. These inconveniences 
may be wholly overcome by the use of artificial teeth such as 
are used at the present day. 

We confess, however, that persons who have several artificial 
teeth will at first experience embarrassment in moving the 
tongue in the articulation of sound. In a few days, however, 
becoming accustomed to their presence, pronunciation will 
become easier, and less unpleasantness will be felt. 

Before indicating the manner of replacing lost organs, and 
retaining them in their positions, we deem it necessary to point 
out the manner of taking an impression of the part of the 
mouth that they are to occupy, and the manner of making 
plaster, sulphur, wax or composition moulds, and also brass 
moulds with mated parts. Whenever natural teeth have been 
lost, artificial teeth may be inserted, and the number required is 
never an obstacle to dental prothesis. 



THE VARIOUS MODES OF TAKING IMPRESSIONS, MAKING MOULDS, 
STAMPING PLATES, &C. &C. 

The place to which artificial teeth are to be attached must first 
be prepared, and an impression of the mouth taken, before the 
artificial piece can be made; thus these teeth can then be properly 
adjusted with reference to those that are in the mouth. For 
the purpose of taking such casts, some dentists use modelling 
wax composed of ten parts of wax and one part of turpentine. 



190 



ma.ury's dental art. 



This wax, however, softens too easily, and, notwithstanding 
the care taken in withdrawing the impression, there is danger 
of having it injured in such manner that the moulds made from 
it will be larger than the natural parts. 

Some practiciens use the white wax, others prefer the yel- 
low, as they are obtained in commerce. These are generally 
preferred to the modelling wax, as they are much firmer. 
We, however, believe that none of these are hard enough, and 
require great care to prevent tine accident we have spoken of. 
This has induced us to use a composition of twelve parts of 
white wax, one part of white lead, and half a part of oil. This 
may be coloured with cochineal, orchanet, or white moss. 
The wax should be slowly melted, the oil then added, and in 
order that the white lead, which is very heavy, may be well 
incorporated with it, the mixture should be well stirred, until 
congealed. 

When we wish to make use of this preparation, we cut it 
into small pieces and place it in warm water, and, when very 
soft, place it in a linen cloth to press out the moisture and 
render it solid. Having attained a proper consistency, it is 
then placed into a tin or silver frame used for the purpose, and 
the impression of the mouth is then taken. 

After having taken the impression, it should be immersed 
in cold water to harden; it may then be placed upon a level 
plane, and surrounded with a border of mastic, an inch in 
height, and adjusted so that the plaster may not escape. A 
sufficient quantity of fine plaster should then be put into a ves- 
sel, and water added thereto until it be brought to such a con- 
sistency as will admit of its running freely. Pieces of fine 
wire should then be inserted into the depressions of the wax, 
that the teeth may not be liable to break from the plaster on 
being withdrawn: a small quantity of the liquid plaster should 
then be poured into the mould, and a slight tap with the frame 
should be made upon the table, that the air bubbles may escape. 
The remainder of the plaster may then be poured in. When 
it has become sufficiently hard the mastic may be removed, 
and a few hours later the wax may also be removed, being first 
softened in warm water; care, however, being taken not to wet 
the plaster if it can be avoided. But this may also be removed 



MECHANICAL DENTISTRY. 



191 



by means of a knife, or by melting before a fire, care being 
taken not to cut the plaster in the former operation, nor to cal- 
cine it in the latter. 

Manner of preparing a Mould of Wax. — After having ob- 
tained an impression as we have directed, we melt common 
wax, and when this is on the point of congealing a small quan- 
tity at a time should be poured into the impression, which 
should have been previously oiled. It will be perceived that 
this wax should not be poured in hot nor in too great quanti- 
ties; for we would thus be liable to melt a portion of the im- 
pression. We may then withdraw the mould before it becomes 
entirely cold, and after having oiled it, as well as the impression, 
they may be placed one into the other. 

Manner of preparing a Sulphur Mould. — This does not differ 
from the foregoing. 

By means of these procedures we may obtain several moulds 
from the same impressions, and finally from one of plaster. 
But as these moulds are not hard enough to enable us to stamp 
up a plate, we are obliged to make one of a composition, of 
eight parts of bismuth, five of lead, and three of tin, or of brass. 
The following is the mode of obtaining these last. 

Manner of obtaining a Metal Mould. — Into a box twelve or 
eighteen inches square, and four inches high, put potter's earth 
moistened, and into this caref illy introduce the plaster, wax, 
or sulphur mould, and in order that the impression may be 
exact, we should render the earth compact around the mould, 
and then let this be carefully withdrawn in order not to enlarge 
the impression. The metal, when on the point of congealing, 
should then be poured into the sand. 

The manner of making brass moulds is similar to the mode 
practised by founders in casting this metal into the various 
shapes desired. Founder's earth or sand is pressed upon all 
the sides of the model ; an exact impression being thus obtained, 
a conduit should be made through which to pour the fused 
metal. The sand, however, should be partially dried, that the 
passage of this may be facilitated. But these moulds cannot 
in general be made with as much facility as the foregoing, and 



192 



maury's dental art. 



they require to be repaired with care after they have been cast. 
They should be scoured in nitric acid diluted, to remove the 
impurities that may adhere to them; and with fine sand rubbed 
on by means of a piece of soft wood their surface should be 
rendered smooth. ^ * 

To stamp a plate we should place it between two hard, re- 
sisting bodies, which may be pressed against each other b}'' 
means of a hammer or vice. The counter mould should be 
somewhat softer than the mould, and of all metals lead should 
be preferred for this purpose. 

The manner of forming counter moulds is simple. A small 
quantity of sand or potter's earth should be placed in a box of 
proper dimensions; the mould sliould then be pressed into 
this, with the back downward, four or five lines deep; this 
should then be surrounded with a piece of sheet iron or paste- 
board, leaving a space of a few lines between this wall and the 
mould. The metal may then be poured upon the mould until 
it is covered to the depth of an inch. The same result may 
be obtained by making in potter's earth an oval or round hole 
larger than the mould. The lead being poured into this hole, 
and when on the point of congealing, we may force into it 
that part of the mould that is to be used in stamping the plate; 
and when both have become cold, they may be separated with 
a hammer. 

Manner of stamping Plates. 

A rough pattern of paper or sheet-lead having been cut out, 
it maybe placed between the moulds and slightly stamped. It 
may then be withdrawn and fashioned into the shape that it is 
designed the plate should have. The pattern thus obtained 
should then be placed upon the metal plate to be used, which 
should then be scribed and cut out by it. In this manner 
there will be less waste of the metal than if a previous pattern 
had not been made. 

The metal plate should be well annealed to render it pliable, 
and adapted to the male mould as neatly as possible by means 
of a pair of round pliers. The corresponding mould should 
now be fitted upon it, and force applied, as before mentioned. 



MECHANICAL DENTISTRY. 



193 



but it would be well to place a piece of iron upon the mould 
to equalize the force applied. 

The plate being properly stamped, it should be reduced with 
a file in all parts that are superfluous, and when thus finished 
it will accurately fit the mouth as designed. (PI. XVIII. 
Fig. 2.) 

Manner of inserting artificial Teeth. 

The loss of one, two, three or four teeth, or a complete den- 
ture, may be remedied by means of artificial teeth; and to such 
perfection, have we arrived in adjusting these that they, in a 
great measure, perform well all the functions of the natural 
organs. 

Artificial teeth are inserted upon pivots, upon metallic plates, 
and upon the sea-horse base, and are sustained by means of liga- 
tures, clasps or springs; and the choice of one or other of 
these various attachments depends upon the nature of the 
case. 

A person having lost a superior incisor, cuspidatus or bicus- 
pis, or even an inferior cuspidatus, or bicuspis, the root of any 
of which may remain in health, we may insert an artificial tooth 
by means of a pivot. If, on the contrary, the root be nearly 
or wholly destroyed, we will then have to insert a tooth upon 
a plate. 

Preparation of a Root previous to the Attachment of an artificial 
Crown* 

It is not often that the root of a tooth is injured by any ac- 
cident that may fracture the crown. To remove any portion 
of the latter, however, that may remain, a file will usually an- 
swer; but if there be any considerable portion of it, recourse 
should be had to a small saw that turns upon a pivot, and by 
means of which we may cut around a tooth. Having removed 
the crown, we should then file the neck off" below the free 
edge of the gum, so that the joint of union between the crown 
and root may be concealed. The canal of the root should 
then be prepared. If the nerve be sensible, its sensibility should 
17 

\ 



194 



maury's dental art. 



be destro}- ed by means of some of the remedies which we have 
already indicated. 

When the root has thus been prepared, we should have un- 
tempered drills of different sizes in readiness, and, commencing 
with the smallest, the dental canal should be gradually enlarged. 
The drill should, from time to time, be withdrawn, and dipped 
into water to prevent its being choked up. Without this pre- 
caution we are in danger of breaking the drill. When a hole 
of sufficient depth has been made with a small drill in this 
manner, we should apply a larger one, and so on, until the ca- 
pacity of the canal is sufficient. This opening should then be 
cleansed by injecting water into it; and b}' means of a slender 
probe, with a piece of cotton attached to the end of it, and 
saturated with alcohol or some stiptic liquid, we may remove 
particles of bone that may be left in the cavity, which should 
then be completely dried. 

Pivot Teeth, and the manner of inserting them. 

We designate as pivot teeth such teeth as are adapted to the 
purpose of pivoting, by having their roots cut off and their 
crowns hollowed out in such manner as to receive a pivot, as 
already described in regard to the roots. These pivots are 
made of platina or gold, but we have seen wooden pivots in 
the teeth of persons coming from America. We are unable to 
discover what species of wood they make use of for this pur- 
pose, but we have known many such pivots to endure longer 
than the teeth in which they had been used. Eight months 
ago we inserted for a friend of ours a human tooth, by means 
of a pivot made of box-wood. This tooth remains very solid. 
Teeth made of the tooth of the sea-horse may be pivoted in 
this manner. When incorruptible teeth are used, the pivots are 
to be soldered to their clamps. 

A pivot tooth should correspond in form, size, colour, and 
all particulars, to the teeth beside which it is to be placed. 
After having sawed it off at its neck, the root upon which it is to 
be placed should be coloured, so that, in placing the crown upon 
it, we may immediately discover the points at which it should 
be filed to cause it to fit closely. A piece of wax may then be 



MECHANICAL DENTISTRY. 



195 



placed between the crown and root, and upon pressing it we 
may discover the exact position that the pivot should occupy 
in the crown. The pivot may then be screwed or riveted into 
the crown. (PI. XVII. Figs. 7, 12.) 

We next, with a probe, measure the depth of the root, in 
order to ascertain the length that we should make the pivot, 
which, being cut to its proper length, should be filed down to 
the size of the drill last used in drilling the root. Notches 
should then be cut in the pivot. (PI. XVII. Fig. 2.) It should 
then be wrapped around with cotton, thread, silk, or, which is 
better, the white skin that covers the birch tree, (Betula Mba, 
Lin.) This kind of skin, composed almost entirely of resin, 
resists for a long time maceration. It is very thin, and may 
be detached very easily from the tree, particularly when green. 
It is better than cork, filaments of asbestos, &c., and does not 
possess the inconvenience of thread, silk and cotton, which be- 
come decayed and emit a fetid odour. For the last ten months 
we have constantly used this article, and the advantages it 
possesses have been daily exhibited. It serves well to main- 
tain the pivot tooth solidly upon the root. We make with 
this pellicle a small strip about a line in width, and having 
dipped it into varnish, as we do all substances used for this 
purpose, we wrap it closely around the pivot, and having dried 
the canal in the root which is to receive it, we put the tooth 
in its place. 

What we have here said of pivoting teeth is only applicable 
in cases in which the canals of the roots are not much injured 
by decay. A tooth inserted in this manner is ver}'' solid, and 
cannot be easily detected. But, unfortunately, we cannot al- 
ways have recourse to a mode of replacement so simple. We 
are sometimes obliged to insert a pivot tooth upon a diseased 
root. Under such circumstances we must proceed as follows:- — 

All the soft parts that can be detached should be carefully 
removed from the root, and one or two little pieces of wood, 
having been previously dipped into varnish, should be placed 
in the cavity in such manner that the pivot of the artificial 
tooth may be inserted with these without doing injury to the 
parietes of the root. Little metal tubes may also be used 
under such circumstances. (PI. XVII. Fig. 11.) But, if the 



196 



MAURY's dental AST. 



root be so much impaired as not to admit of these auxiUary 
means, we may then have recourse to plates, ligatures^ and 
clasps, which we shall describe after relating the accidents 
sometimes attendant upon the insertion of pivot teeth. 

These evils may be produced by a pivot that is too large or 
too long, or by its breaking in the root. In the first case, it 
may touch the remaining portion of the dental nerve, and thus 
pain, inflammation, abscess, fistules, or a puriform discharge 
occasioned by a cyst at the root, may be produced. (PI. IV 
Fig. 3.) In the second case, the broken pivot may remain deep 
in the root, particularly if brittle metal be used; but this acci- 
dent is of unfrequent occurrence. To remedy it, however, is, 
sometimes difficult. Should the fragment of the pivot be too 
deep to be grasped with forceps of proper construction, a drill 
may be introduced on opposite sides to admit of the insertion 
of a suitable instrument. 

We may also use for this purpose an instrument constructed 
by M. Miel, and which, having modified, we have used during 
fifteen years. It is made of soft steel, and is cylindrical in 
shape; its diameter is about three or four lines; its extremity 
is denticulated; it is open for the distance of about six lines 
from this extremity, and the edges thus approximating are thin 
and elastic, and capable of passing each other upon pressure 
being made externally upon the tube. This instrument may 
be fitted to a socket handle capable of receiving such of differ- 
ent sizes. (PI. XIV. Fig. 5.) 

When this instrument is to be used, the distance between the 
branches should be regulated and adapted to the size of the 
pivot to be withdrawn. By giving to this a rotary movement 
on insertion into the root, it penetrates with facility, as the ter- 
minal saw not only destroys the little inequalities, but also 
the intermediate substance between the root and the pivot. 
Loosened in this manner, the pivot may be withdrawn by means 
of narrow beaked forceps. 

We have already remarked, that in inserting a pivot tooth 
regard must be hud to the condition of the root; hence it 
would be imprudent to insert one upon a root that has been 
impaired through the whole length of its canal. The puri- 
form discharge that exists in such cases, particularly if the 



MECHANICAL DENTISTRY. 



197 



subject be young, being suddenly suppressed, would occasion 
evils similar to those produced by pivots of too great length. 
If, however, we are obliged to insert a pivot tooth upon a root 
much diseased, we should merely render it firm enough not to 
drop out, and thus let it remain until the discharge has ceased 
or obtained another passage^ when the pivot may be rendered 
firm.* 

These evils may also be alleviated by the application of 
leeches over the diseased root. Pediluvia, soothing gargles, 
emollient and narcotic lotions made of marsh-mallow root, 
barley, figs, honey, and a poppy-head; and when the inflam- 
mation has subsided we may substitute for these remedies, tonic 
lotions, prepared with some .alcoholic liquid, which should be 
used twice or thrice daih^ until the part has been restored to 
health. We should not, as is often done, merely wash the teeth 
with these lotions, but they should be retained in the mouth 
for a time, and the diseased gums should be slightly rubbed 
with a brush saturated with them. 

LIGATURES, PLATES AND CLASPS USED TO RETAIN ARTIFICIAL 

TEETH. 

If any of the modes of retaining teeth could be applied under 
all circumstances, there would be no occasion for the variety of 
methods named. Attaching teeth by pivots is certainly the 
best means; but as there are certain conditions essential in 
this operation which we do not always meet with, it is neces- 
sary to resort to other means. Ligatures, metallic plates and 
clasps are therefore used. 

* We would here express our decided disapprobation of the practice of 
inserting teeth upon roots in the condition described. Health should first 
be restored to the part; or, if this be impracticable, the root should be ex- 
tracted, and in due time the tooth should be inserted upon a gold or platina 
plate. There are cases, however, in which, without pain, a discharge slightlv 
ichorous is for some time emitted. In such cases, a recent invention of Dr. 
W. fl. Elliot, will apply very aptly. It consists of a small gold tube passed 
through the pivot, and having an opening continuous with it through the 
artificial crown. 

To permit the discharge to find "another passage," (i.e. through the 
alveoli and gums, we suppose,) is a recommendation that hardly needs a 
comment to malie apparent its absurdity. — S. 

17* 



198 



maury's dental art. 



Ligatures. — Ligatures used to retain teeth in their places 
are made of raw silk, an article known in commerce by the 
name of Chinese root, aloes, platina or fine gold. 

Some discretion must be exercised by the dentist in regard 
to the proportions of the ligature to be applied, as this will 
depend upon the exigencies of each particular case. 

Raw Silk. — This must be wrought into what is called twisted 
raw silk. In this state it is very strong. It does not decom- 
pose in the mouth so soon as ligatures made of ordinary silk, 
hemp, or flax; but, like these last, it possesses the inconvenience 
of being seen, and of swelling more or less according to its 
degree of tension. The more tightly these ligatures are drawn, 
the greater their liability to approach the gums and inflict in- 
jury upon them. 

China Root. — This article is nothing else than raw silk, 
twisted very hard, stretched, and immersed into copal varnish. 
This ligature will not contract nor become injured by the juice 
of the mouth, so soon as the others we have enumerated; al- 
though it is not wholly impervious to these fluids. 

Thread of Aloes. — This is taken from the silk worms at the 
time they are going to spin. It is dipped into vinegar, and 
afterward stretched into pieces two feet in length ; it is then 
extended upon a plank with its ends secured that it may not 
contract, and sufiered to dry in this situation. This ligature is 
stronger than the former, and is scarcely perceptible upon the 
teeth. Its only inconvenience is its tendency to stretch on 
becoming wet; but this may be remedied by steeping it in 
warm water for half an hour before applying it. 

tMetallic Ligatures. — Gold and platina are the only metals 
used for this purpose. They are more durable than other liga- 
ments, but are difficult to conceal. They wear away the teeth 
sooner than other ligatures, are inelastic, and require to be 
rendered malleable before being used. 



MECHANICAL DENTISTRY. 



199 



Plates, Clasps and Springs. 

Plates.— These are always made of gold or platina when 
artificial teeth are to be inserted upon them. They should ac- 
curately fit the part they are to occupy, sometimes extending 
a few lines on the inner side of the alveolar border. The 
pressure upon the gums should not be too strong, as the neigh- 
bouring teeth may thus be loosened. 

Clasps. — Small branches of gold or platina, round, half round, 
or flat, are thus denoted. They are soldered or riveted to the 
artificial piece, and their extremities serve to secure such piece 
to the adjacent teeth. Their form varies according to each 
particular case. (PI. XVIII. Fig. .9.) 

Springs.— These difier from clasps in being made of gold 
less pure than the former, and in being longer, that they may be 
applied to teeth remote from the artificial piece. (PI. XVIII. 
Figs. 5,11.) 

ARTinCIAL TEETH, THEIR FABRICATION, AND MODE OF 
ATTACHMENT. 

Dentists have given the name of blocks or pieces to several 
teeth united and retained in the mouth by means of ligatures, 
plates, clasps, or springs. These pieces or parts of sets are 
sometimes carved out of a single piece of the tooth of the 
sea-horse; sometimes they consist of human or incorruptible 
teeth mounted upon a sea-horse base. Whatever may be the 
plan adopted, the part to be occupied must first be prepared, 
and an impression taken in the manner heretofore indicated. 

Teeth, carved from the Sea-horse Tooth. 

In order to adapt the base of these to the mouth, a plaster, 
wax, or sulphur mould is preferable even to metal. We 
should be provided with two of these; by one the piece may- 
be cut out roughly, and it may be finished by the other. The 



200 



maury's dental art. 



piece of sea-horse tooth used should be always larger than 
the space to be filled. It should be enamelled anteriorly, that 
the three or four anterior teeth may be furnished with enamel. 
To give the form of the teeth, it is only necessary to scribe out 
the form of the teeth and carve them superficially. 

If a plaster mould be used, we should first cut away one or 
two lines from the sides of the teeth adjoining the space to be 
filled, that the piece may be too large, rather than too small. 
The cast should then be covered with black or red paint 
slightly gummy; the piece applied to this will exhibit upon its 
prominent parts marks indicating the points at which it should 
be reduced. The rasp may be used upon the block of sea- 
horse until it be partially adjusted, when the flat graver should 
be resorted to. As we carve the piece slight portions only 
should be removed at a time. This precaution should be ob- 
served until a perfect fit has been made. 

' The repeated application of the piece upon the mould may 
wear the latter away. The second mould may then be used, by 
which it may be completed. The base being thus adjusted, the 
teeth may be carved out upon it, and reduced to a proper 
length. It may then be applied to the mouth for which it was 
intended. 

These general rules are applicable to one or more teeth 
carved out of the sea-horse tooth. 

J^atural Teeth mounted upon the Sea-horse Tooth Base. 

The first thing to be done here is to adjust the base as de- 
scribed in the preceding remarks. The teeth being selected, 
their roots should be sawed ofi* at a proper place, and they 
should then be placed upon the base in their right positions, 
and secured by means of sealing-wax. This being done, a hole 
should be drilled through the base and into the tooth, and a 
rivet temporarily inserted. (PI. XVII. Fig. 16.) These 
should then be withdrawn, and larger pins or a screw inserted. 
(PI. XVII. Fig. 17.) The teeth having been thus attached, 
and the base coloured so as to imitate as nearly as possible the 
gums, it should be rubbed with shave-grass, and polished with 
the same material and a little powdered pumice stone. With 



MECHANICAL DENTISTRY. 



201 



a brush and water we may then remove all particles of foreign 
matter. 

A rose colour may be imparted to the sea-horse, by putting 
muriatic acid adulterated upon it. It should then be dipped 
into common water, and having been dried, we may imitate 
the gums by spreading upon it a coat of vina'igre rouge de mailUf 
which ladies generally use in their toilet. 

Half-round files are made use of to clean the teeth 1 us in- 
serted, and they may be polished also with a piece of soft wood 
and pumice stone, and afterward with, a little Spanish white. 

Incorruptible Teeth mounted upon a Sea-horse Tooth Base. 

These are mounted in much the same manner that the 
natural teeth are. They require some variation in their mode 
of application in consequence of a groove with which they are 
provided. It is necessary that we should ascertain the precise 
spot upon the base that is to correspond with this groove. 
This may be done by the use of a piece of wax with which the 
tooth is temporarily attached to the base. When the tooth is 
detached an impression will be made upon the wax by the 
fissure, wliich will indicate the place that should be drilled to 
receive the pivot of the incorruptible tooth. This pivot is 
afterward to be riveted to the base. 

Human Teeth mounted upon a metallic Plate. 

Having stamped and prepared a plate as we have indicated, it 
should be placed upon a plaster cast with a piece of wax. The 
teeth to be inserted should then be sawed in such manner as to 
be of full length. Their extremities should be then dipped in 
red colouring matter, and placed upon the plate. When with- 
drawn, the place left coloured by them will indicate the situa- 
tions they should occupy. 

A small hole in the heel of the tooth and a corresponding 
one in the plate being made, and a pin being passed through 
these, the teeth may be retained in their places. (PI. XVH. 
Fig. 13.) 



202 



Maury's dental art. 



All the teeth being thus properly adjusted, pivots of proper 
size should be soldered upon the plate; the holes made in the 
teeth should then be enlarged to suit these pivots, and the 
teeth adapted to the plate: by means of these pivots, which are 
riveted at the posterior sides of the teeth, these are retained. 
Screws are sometimes used for this purpose. These are to be 
screwed into the teeth with a piece of the inner skin of the 
birch tree dipped in varnish. Many English dentists employ 
no other means to secure artificial teeth to the plates. This 
mode is preferable to riveting the pivots; they can be more 
readily adjusted in this manner, and we can remove the tooth 
without breaking it or diminishing the length of the pivot. 

Teeth are sometimes fastened by means of several pins 
passed through the plates and into their bases; but this mode 
is inferior to that of securing with a single attachment. 



INCORRUPTIBLE TEETH. 

JYIode of Application. — These are furnished with three little 
clamps, (PI. XVII. Fig. 9,) which are inserted into them pre- 
vious to their being baked. A little metal stud is to be em- 
braced by these clamps, and soldered to them to retain the 
teeth upon the plate. 

The incorruptible teeth are generall}^ made without a heel; 
thus constructed, they do not touch tbe teeth in the opposite 
jaw, are more easily adjusted to the plate, and occupy less 
room in the mouth. Sometim.es, however, a heel is made of 
metal, and is soldered to the pin with the tooth. (PI. XVII. 
Fig. S.) These heels are not so thick as those made of the 
substance of the artificial tooth, are stronger, and are more 
easily adjusted to the base. 

Manner of adapting the shape of artificial Teeth.— A hard 
grind-stone, from twelve to twenty inches in diameter, is used 
for this purpose. This grind-stone, the sides and surface of 
which should be well dressed, should turn vertically, and dip 
into a trough containino; water. A suitable contrivance should 
also be made to prevent the water from flying from this when 



MECHANICAL DENTISTRY. 



203 



revolving, and to catch a tooth as it falls from the hands of the 
person holding it, an accident likely to happen to one not 
practised in this operation. 

A grind-stone, similar to those used by glass-cutters, is also 
necessary; others of softer texture may also be required. These 
should be about six inches in diameter, and ten lines in thick- 
ness. They should be wet whenever used. Wheels of iron 
and steel are also used in the process of shaping these teeth. 

Incorruptible teeth may be modified in shape in all parts 
except upon their enamelled surfaces. If, however, they be too 
brilliant, a duller hue can be given them by rubbing them with 
moistened pumice stone. If they be too convex, this may be 
reduced by grinding; and they may be again polished by 
means of a wooden wheel, having finely powdered pumice 
stone applied to them damp: to complete this operation, dry 
pumice stone of a still finer texture may be used.* 

Manner of Soldering a Pivot to an Incorruptible Tooth.—^ 
There is, as we have described, a perpendicular groove in these 
teeth, and clamps are inserted into them, previously to their 
being baked or hardened, at the sides of this groove. A stud 
being fitted into this, and these small platina clamps secured 
upon it, we solder them to it. A pivot adapted to the root, to 
which this is to be applied, may now be attached to this stud, 
or the pivot and stud may be constructed of an entire piece, 
and adapted previous to the attachment of the tooth. 

To solder well is not difficult, but requires certain precau- 
tions which we shall point out. 

The teeth to which we would attach a metallic stud, should 
at first be gradually heated, as the sudden application of heat 
would cause them to crack. While heated, the enamel should 
not be suffered to come in contact with any hard body, as it 
may thus become tarnished. The flame applied to melt the 
solder should be concentrated, and removed the moment this 

* The teeth spoken of by our author are the French manufacture, it will 
be remembered, and which require to be shaped and adapted by tlie hands of 
the dentist. The superior mode of manufacturing teeth in this country, and 
perhaps in France too, at present, render unnecessary the author's minute- 
ness of description as to the manner of grinding them. — S. 



204 



maury's dental art. 



object is effected, as its continuance would diffuse the solder 
and render the attachment weak. If, as sometimes happens, 
the teeth appear smoked and dingy, we may restore their pri- 
mitive colour by exposing them to a pure fire, and afterward 
immersing them in water, to which a small quantity of nitric 
acid has been added. 

In attaching incorruptible teeth to a plate, (PI. XVIII. Fig. 
4,) the adaptation of this being first completed, the teeth should 
one by one be adjusted to their places and retained by means 
of wax. With vermilion or other colouring, the situation of 
the groove in the tooth is marked upon the plate. The teeth 
are then removed, and at each point thus marked a pivot is to 
be attached so as to exactly correspond to the groove of the 
tooth when replaced. (PI. XVIII. Fig. 3.) The teeth, thus 
arranged, may now be soldered. These attachments being 
completed, the work should now be smoothed off with a file, 
and afterward with pumice stone, &c., and finally by means of 
a burnisher. 

Artificial teeth thus prepared may last a long time. Should 
any accident, however, occur to them, it may readily be reme- 
died. To do this the plate and teeth should first be well cleaned. 
The manner of doing this is as follows; First, brush them well 
with soap and water, and dry them slowly before the fire. 
When the metal has become red in this situation, the piece 
should be slowly cooled, scoured, and boiled in pure water. 
The piece will now exhibit its former brilliancy, and may be 
proceeded with as when new. 

COMPLETE SETS, AND THE MEANS OF THEIR ATTACHMENT. 

The loss of the teeth of one or both jaws may be supplied 
by means of artificial teeth constructed into what are termed 
complete dentures or sets, which are secured in the mouth by 
means which will be described hereafter. 

The form, size, mode of attachment, &c., of dentures are 
various as the cases to which they are applied. As regards the 
materials of which they are constructed, they are the same as 
in the partial sets already spoken of. 



MECHANICAL DENTISTRY. 



205 



In preparing to construct these, our first measure should be 
to remove all such teeth or roots as offer impediment; or, should 
there be roots remaining in a healthy condition, they should be 
filed even with the gum, that they may not interfere with the 
plate. The presence of these is indeed desirable, as they pre- 
vent the absorption of the gum, and thus preserve the form of 
the mouth and alveolus, and facilitate the adaptation of the 
artificial piece,* When the mouth has been thus rightly pre- 
pared, we may proceed to construct the plate, and to adjust 
the teeth to it. 

Complete Sets made of the Sea-horse Tooth. 

An impression of each jaw should be first taken, and after- 
ward an impression of both jaws at once. This latter is called 
an articulating cast. The plaster moulds having been made 
from these, pieces of sea-horse tooth of adequate size should 
be shaped and adjusted, and the desired form given to them. 
The internal and external contour of the denture should also 
be roughly formed. These should then be tried in the mouth 
of the person for whom they are intended singly, and if adapted 
to it, they should be withdrawn and a piece of wax placed be- 
tween them, that they may adhere, and then returned to the 
mouth again; or without this being properly antagonized, they 
may be united in the mouth by means of sealing-wax applied 
to the cuspidatus teeth, which are the more prominent. When 
thus removed together, an articulating mould may be made 
from them. 

It is only after this mould has been made that we can judge 
of the relation that these teeth will have with each other; and 
it is by this that we are to determine the shape of the dentures 
anteriorly and posteriorly. 

Having ascertained that in all these particulars our work is 
well adjusted, nothing will remain but to proceed to carve out 

* This is incorrect. There are eases in which a healthy root may be made use 
of to sustain a plate, but even this should not be done where other advantageous 
means of support can be had; in no other case is it proper to place a plate 
over a root. Its presence will work evil: sooner or later it must be removed 
and the patient will thus be subjected to a repetition of the trouble and expense 
incurred in having the artificial tooth or teeth inserted. — S. 

18 



206 



maury's dental art. 



the teeth. These should be first made a little longer than we 
desire ultimately to have them: if we wish them to close di- 
rectly upon each other, the cutting edges of those first formed 
should be marked with vermilion, and the traces left by these 
upon their antagonists will indicate the manner in which they 
are to be carved. 

When we wish that all these teeth should be covered with 
enamel, it will be necessary to attach several pieces together 
by means of rivets, in order that an enamelled front may be 
presented. 

Complete Dentures of human and incorruptible Teeth upon a 
Base of Sea-horse Tooth. 

These dentures only differ from the preceding in having 
sixteen or twenty natural or incorruptible teeth riveted to bases 
of sea-horse tooth. All that we have said relative to the 
adaptation of complete dentures of sea-horse teeth is applicable 
to these: eight or ten human or incorruptible teeth, for each jaw, 
should be selected for this purpose with much judgment. Tw^o 
molar teeth should be carved at each extremity of the bases to 
which these teeth are attached. (PI. XVII. Fig. 15.) 

Complete Sets of human Teeth upon Gold or Sea-horse Tooth 

Bases. 

The directions already given in regard to the preparation of 
partial sets of these teeth, in connexion with the foregoing 
remarks upon complete sets, render minute description of this 
operation unnecessary. The mode of taking a cast of the 
mouth, and of making plaster and other moulds therefrom, in 
the former, and the manner of articulating described in the 
latter, is here applicable. 

Superior Dentures maintained by means of a metallic Plate 
adapted to the inferior Jaw. 

The superior teeth being lost, and the inferior, or a greater 
portion of them being preserved-, artificial teeth may be sus- 



MECHANICAL DENTISTRY. 



207 



tained in the superior jaw by means of spiral springs. To pro- 
cure means of attaching these springs, a metallic band should 
he adjusted along the inferior jaw, to which studs should be 
connected for the attachment of the springs. This band 
should not exceed four lines in width; otherwise it would ex- 
tend to the fraenum of the tongue, and a pressure would then 
be exercised upon the teeth which would cause them to incline 
•anteriorly. This pkt<3 should conform to the contour of the 
dental arch. It should be of sufficient thickness to have teeth 
attached to it by means of an extension over such parts as have 
been deprived of these organs. This band may be rendered 
more solid by adjusting upon a bicuspid of each side of the 
mouth a cap which should accurately ht it. (PI. XX. Fig. 3.) 

MANNER ©F ATTACHING DENTURES IN THE MOUTH BY MEAN^ 
OF SPIRAL SPRING-S. 

The means by which we attach double sets in the mouth diffei 
materially from the mode of inserting partial sets. Springs 
of simple construction, called spiral springs, are used for this 
purpose. (PI. XX. Figs. 2, 3.) These are attached by the an- 
terior bicuspid by m.eans of a stud inserted horizontally into 
the plate to .serve as a pivot or axis for the spring. 

J^Ianmr of maldng spiral Springs^ 

Spiral springs are made of gold wire of eighteen carats. 
This wire should be prepared by being passed three or four 
tiimes through a drawing plate to redfuce it to a proper size. 
It should then be annealed, and again passed through the 
plate in order to condense it well. It may now be cleaned by 
being boiled in diluted nitric acid, and afterward rubbed with 
pumice stone by means of a piece of soft leather. The opera- 
tion of polishing may be completed with rouge. It should 
then be wound into a spiral form upon a lathe, or by means of 
a vice; the adaptation of apparata for this purpose will depend 
much upon the invention of the operator, as many modes are 
Ksed by difc-ent dentists. 



208 



MAURT's DENTAL ART. 



Spring Carrier. — We call by this name a little structure pro- 
ceeding from the artificial piece to which the spiral springs are 
to be attached. (PI. XX. Fig. 5.) It consists of a pin rising per- 
pendicular to the piece, from which a projection again issues 
horizontally at a proper height, say from five to eight lines. 
Upon this last process the end of the spring is to be attached, 
and made to revolve between two rings or small plates made 
to confine it and to protect the cheek from being afiected by 
its action. 

To the ends of the springs are attached gold or platina pieces 
shaped into eyelets which are to revolve upon the spring carriers 
already described. (PI. XX. Fig. 4.) 

Spiral springs present two advantages that render them su- 
perior to all others: First, the facility with which they may be 
executed; secondly, the firm manner in which they act, and 
their durability. 

A precaution necessary to be observed in applying these 
springs, is, that the point of attachment, by means of the spring 
carrier, should be accurately ascertained, as the least deviation, 
backward or forward, will render them unavailable. 

So well adapted are these springs to the purposes for which 
they are designed, that, occupying little space in the mouth, 
the patient soon becomes unconscious of their presence; and 
whatever annoyance may be experienced, will arise from the 
presence of the teeth themselves. This, however, should be 
endured for a few days, as in that time use will remedy it. 

OBTURATORS, OR THE MEANS OP REMEDYING LESIONS OF THE 
PALATINE ARCH. 

Unnatural communications between the mouth and nasal 
fossae, not only proceed from accidental diseases, but are some- 
times congenital. The separation of the palate bones, and of 
the soft palate, sometimes accompany hare-lip. For this sepa- 
ration, art has as yet only effected a palliative remedy. M. 
Roux, however, one of the most celebrated surgeons of Paris, 
several years since attempted to perform upon the soft palate 



MECHANICAL DENTISTRY. 



205 



an operation similar to that by means of which we remed}'- 
hare-lip. Complete success favoured the happy idea of this 
learned professor, who, since that time, has had occasion to 
perform this operation several times. He has given to it the 
name of Staphyloraphy. 

Congenital lesions of these parts come properly under the 
cognizance of the surgeon; we will, therefore, content ourselves 
with pointing out the causes of accidental communication be- 
tween the buccal and nasal cavities. 

Various accidents, but especially fire arms, may occasion 
a wound in the palatine arch, with such loss of substance and 
destruction of the bone, as to jender it impossible to effect a 
perfect cicatrization of the parts. Venereal ulcers do not al- 
ways limit their ravages to the mucous membrane of the palate 
and palatine roof, but are often extended to the bones themselves, 
which, becoming necrosed, (PI. XIX. Fig. 5,) a perforation or 
loss of substance is the result. There are cases in which the soft 
palate is divided. (PI. XX. Fig. 8.) This constitutes one of the 
most serious evils. Particles of aliment, no longer confined by 
this part, pass into the nasal fossae and trachea, and occasion 
sufibcation, always very annoying, and sometimes dangerous. 
Pronunciation is imperfect, and sometimes unintelligible. To 
remedy these inconveniences various means have been con^ 
trived, called obturators, which are intended to obliterate the 
accidental opening. 

The obturators first used were very simple. They were 
made of sponge, cotton, wax, mastic, or other substance capable 
of closing up the opening in the palate. But these were found 
insufficient, and metallic obturators sustained by sponge, me- 
tallic clasps, a button, or bolt, obturators with moveable wings, 
obturators attached to a plate to which teeth were also attached, 
&c. were used. We shall describe these several kinds. 

Obturators sustained by Sponge, 

This obturator, which was introduced by Ambrose Pare, is 
composed of a metallic plate adapted to the concavity of the 
part to which it is to be applied, and larger than the opening 
by one or two lines in circumference: a little metallic rim, 

IS* 



210 



MAURY^S DENTAL ART. 



higher than the thickness of the walls of the part, is to be at- 
tached to the convex side of this plate. (PL XX. Fig. 9.) 
In this latter circle or rim several holes are pierced to pass a 
metallic or silken ligature to which a piece of sponge of pro- 
per size is attached, and introduced through the opening into 
the nasal fossae. The sponge, once introduced into the nasal 
fossag, becomes saturated with mucus, swells, and by resting 
upon the floor of the nasal fossae., retains the plate firmly in 
its position. 

It will be perceived that an obturator of this kind, though 
of easy application, possesses disadvantages. In the first place 
the expansion of the sponge from moisture, dilates the hole, 
instead of facilitating its contraction; secondly, its long re- 
tention in the mouth occasions a fetid odour. 

Obturators sustained by Clasps. 

The opening in the palatine roof may cicatrize in time, pro- 
vided no foreign body should prevent it. Obturators sustained 
by a sponge were on this account discarded, and a plate sub- 
stituted. This plate is simply placed over the opening and 
sustained by means of ligatures or clasps attached to the teeth. 
(PI. XX. Fig. 1.) 

Obturators sustained by a Button. 

This kind of obturator consists of a metallic plate like the 
preceding; upon the convex side of which is soldered a circu- 
lar eminence extending as high up as the walls of the wound; 
upon this is adapted a kind of oval button, which is about half 
a line larger than the wound. (PI. XX. Fig. 10.) It is neces- 
sary to use some force in introducing this button; but being 
inserted as far as its neck, it will then hold the plate imme- 
diately in contact with the palatine roof, and prevent the air 
from entering the nasal fossae. 

Obturators sustained by a Bolt, and Obturators iDith moveable 
Wings. — [These obturators are ingenious and complicated in 
their construction, but of no practical utility; and as they can- 



MECHANICAL DENTISTRY. 



211 



not be intelligibly explained without the aid of minute draw- 
ings, the translator has deemed it justifiable to omit them.] 

Obturators connected with Dentures. 

These only differ from obturators connected to the teeth by 
means of ligatures and clasps in the length of the plate which 
extends over the alveolar border, and to which artificial teeth 
are attached. We may insert four, six, ten and even twelve 
teeth upon these extended plates. To the ends of such plate 
clasps should be attached to secure it to such of the natural 
teeth as will afford it support. Plate XX. Fig. 11, represents an 
obturator of this kind, furnished with twelve teeth, which we 
made several years ago for a woman thirty -four years of age. This 
woman was under antisyphilitic treatment from her fifteenth 
year. The plate of this obturator is constructed so as to close 
hermetically two large openings in the palatine roof ; and one 
of its borders closes a third opening which communicates with 
the maxillary sinus. This woman appears to enjoy good health; 
she is large and fleshy. At times, however, she experiences 
violent headache from which she suffers much, even for a week 
continually. 

It will be difficult to point out precisely the particular cir- 
cumstances under which each of these obturators should be 
applied. The choice should always depend upon the nature of 
the disorder to be remedied. 



THE CARE NECESSARY FOR THE PRESERVATION OF ARTIFICIAL 

TEETH. 

Persons who wear artificial teeth cannot take too much care 
to preserve them in a condition of perfect cleanliness. We 
have already spoken of the necessity of having a second set 
to replace those worn, should they be injured. It is well to be 
thus prepared for such accidents, since even sound natural teeth 
are not wholly exempted from them. It will be well also to 
lay aside for a few days, from time to time, teeth made of ani- 



212 



maury's dental art. 



mal substance, as they may thus be preserved longer. They 
should be cleaned with a hard brush and soap and water, and 
with a weak solution of soda or bi-chloride of lime. Having 
been well dried and enveloped in a piece of linen, they should 
be put in a dry warm place. A piece thus preserved loses the 
moisture it may have absorbed, and the bad odour with which 
it may have been impregnated. These precautions are also 
necessary to prevent the piece and teeth from cracking. 

If pivot teeth, well adjusted and secured to sound roots, re- 
quire no particular care, it is not the same with animal artificial 
teeth retained by means of ligatures, springs and clasps. These 
require great care, because resting upon the soft parts, the 
viscid secretions of the mouth are deposited between these 
soft parts and the artificial pieces where they are not well ad- 
justed. We should not wait for pieces sustained by ligatures, 
especially animal or vegetable, to become loosened before re- 
newing their attachment. We should, on the contrary, replace 
them by attachments more durable. The larger an artificial 
piece is, the more care it will require. 

Artificial teeth composed of sea-horse teeth require more 
care than those composed of human teeth, and if neglected 
will become very unpleasant ; but the necessity of cleansing 
all of them daily is apparent. 

ARTIFICIAL GUMS. 

When the loss of the substance of the alveolar border is 
very great, it should be repaired. The manner of doing this 
is by carving an imitation of the gums upon artificial pieces; 
these pieces should be first well adapted to the part, that, after 
the gums have been carved out, they may not require to be 
retouched. 



A TREATISE ON MECHANICAL 
DENTISTRY.* 

CHAPTER L 

1. It is no part of the design of this series of articles, writ- 
ten at the repeated solicitation of many of my professional 
brethren, either to demonstrate the general utility of artificial 
teeth, or to persuade the community to procure them. The 
wants of the student in dentistry will be consulted and met, 
as far as practicable, in the following treatise; and no pains 
will be spared by the author, in his efforts to collect and com- 
municate in the plainest terms, all the practical instruction 
which the present condition of our art can supply. 

2. Each section of this treatise will be numbered for the sake 
of convenient reference, and as many explanatory cuts will b6 
given as the nature of the subject may demand. If, in at- 
tempting to make the details of the art perfectly intelligible 
to the student, the author should seem to the older members 
of the profession to be too minute in his illustrations, they 
will, no doubt, on a moment's reflection, admit the validity of 
his excuse. 

3. By MECHANICAL DENTISTRY is Understood the art of con- 
structing sets and parts of sets of artificial teeth; of inserting 
single teeth on roots or fangs; and of constructing artificial 
palates in cases where the natural organ is deficient. 

A description of the method of proceeding in every sup- 
posable case will be the object of this series of papers. 

4. The implements proper to the mechanical dentist will be 

The first three chapters of this treatise are part of Dr. Solyman Brown's 
excellent article, published in the American Journal of Dental Science. For 
the fourth chapter we are indebted to Professor C. A. Harris. — S. 



214 



maury's dental art. 



minutely described as they become necessary in the progress 
of the work; it being premised that a bench, hammers of various 
kinds, an anvil, vice, files, &c. must be understood to be es- 
sential. 

5. It being the opinion of the author, founded on a settled 
conviction resulting from observation and experience, that the 
necessity of using human teeth, blocks of ivory, or other 
animal substance, is wholly superseded by the great improve- 
ments which have been recently made in the manufacture of 
incorruptible, mineral teeth; the directions given in this essay 
will relate exclusively to the latter, which he hopes every ho- 
nourable practitioner will endeavour to introduce into his prac- 
tice, to the exclusion of all substances which are liable to be 
decomposed by the fluids of the mouth, lose their beauty, and 
infect the breath with loathsome poison. 

Of the Insertion of a single Tooth on the natural Root. 

6. As broken parts of the crown often remain attached to 
the root, a pair of excising forceps becomes necessary. This 
instrument should be about five inches in length, having the 
cutting edges one-tenth of an inch in breadth. 




In this wood cut (a) represents the forceps, and (6) the 
breadth and shape of the cutting edges. These forceps should 
be of sufficfent strength and material not to bend or spring 
under the pressure of the hands, and should be used with such 
gentleness as not to strain, shake, or otherwise injure the root. 

After the prominent parts of the crown shall have been 
removed by means of the forceps above described, as nearly 
as possible to the semi-ciicular arch of the gum, a round, ellip- 
tical or half round file is employed to complete the process. 



MECHANICAL DENTISTRY. 



215 




The file should be fine-cut, and ought to be used with de- 
licacy, as well to save the sensibilities of the patient, as to avoid 
agitating the rOot to such a degree as to produce inflammation 
of the investing membrane and surrounding structure. 

7. When the file has reduced the root to the edge of the 
gum, and even a little beyond it, the next operation is to per- 
forate the fang, by enlarging the natural nervous tube by means 
of a broach or hand drill of something like the following con- 
struction. 



The point may be either square, or pentagonal like the com- 
mon watch-maker's broach, and should be of sufiicient size to 
produce an orifice capable of receiving a pivot of the size of a 
large knitting needle. Several broaches of smaller sizes are 
necessary to enlarge the natural orifice by degrees to the re- 
quired diameter. The depth of the orifice should be one-fourth 
of an inch, in roots that will admit of it. 

8. Select a mineral tooth as nearly as possible of the colour 
of the adjacent teeth, taking care that the shade never be lighter 
than that of the natural teeth in the same mouth. Let it be 
moreover of the proper length, breadth, and thickness, with 
as little grinding as possible. Some change of shape and di- 
mensions is however generally necessary, for which a suitable 
grinding apparatus is indispensable. Machines for grinding 
mineral teeth are of various kinds, of which a common grind- 
stone is the most obvious and simple. Small and portable 



216 maury's dental art. 

stones for the use of dentists, are prepared and mounted by 
dental instrument-makers, of which the following is a draft: 




An improvement on this construction has been attempted by 
Messrs. Royce &Esterly, ingenious dentists, resident in Pough- 




keepsie, in the state of New York. This grinding apparatus 
consists of simple system of cog-wheels by means of which 



MECHANICAL DENTISTRr. 



217 



ene of the two stones has an accelerated motion. This patent 
has the adv^antage of elegance of structure, neatness in the 
operation, and the easy change of stones of various dimensions; 
and is moreover well adapted to the use of a newly invented 
grinding wheel, which will be described hereafter. 

The two foregoing machines for grinding teeth, are well 
adapted to the use of travelling dentists; but for those members 
of the profession who are stationary, foot lathes are much the 
most efficient. These may be of very simple construction, 
thus; 




Lathes constructed on this principle may be enclosed in 
ornamental cases, and thus become articles of furniture not un- 
becoming the operating room of the genteel dental surgeon; 
but they are generally better fitted to the laboratory of the ar- 
tificial workmen. 



19 



218 



maury's dental art. 



Of the stones or wheels employed in grinding mineral teetfi^ 
many varieties are in vogue. Some good workmen use vvoodeo 
wheels about six inches in diameter, the circumferences of 
which are turned into convenient forms, and covered with hot 
glue and emery. These are commonly called emery wheels, 
and have been long used in the mechanic arts. 

Many dentists still adhere to the use of grind-stones of small 
dimensions, but from recent exj>eriments I am led to prefer a 
composition wheel made of shellac and emery, combined in 
certain proportions when hot, afterwards cooled in moulds of 
strong metal provided expressly for the purpose, in which the 
material is compressed by great mechanical force. 

10. The evident advantages of this species of grinding appa- 
ratus are, first, its little liability to change of form from con- 
stant use; secondly, its capability of retaining sharp edges^ 
corners and curves, longer than any other substance hitherto 
employed; thirdly, its economy, being exceedingly durable; 
and fourthly, the mechanical correctness of its execution, arising 
from its hardness and solidity. 

The following are some of the convenient forms of the 
cutting edges of these wheels, as they come from the moulds. 



V 



Although these edges, corners, planes and curves remain 
long with little apparent change, which is by no means true of 
any other wheels used for the purpose excepting copper ones; 
yet it must be evident that constant use will more or less 
change those original forms, unless the mode of grinding upon 
them shall be calculated to preserve the primitive shapes; a 
point to which ordinary ingenuity will direct the attention of 
the artist. 



MECHANICAL DENTISTRY. 



21S 



11. As the manufacture of these wheels is attended with 
considerable expense, in the way of moulds and presses to give 
form and compactness to the materials used, it is presumed that 
dentists will prefer to purchase rather than to make them, and 
therefore any farther description is deemed superfluous. 

When the tooth has been carefully and accurately fitted to 
the stump or root by grinding, and made of the proper length, 
breadth and thickness, it may be fixed temporarily in its place 
with a pivot of white pine, poplar or other soft wood, for the 
purpose of affording the patient an opportunity of suggesting 
any alteration that may be desired. 

12. When all parties are fully satisfied with the appearance 
of the artificial substitute, and when the antagonizing teeth in 
the opposite jaw meet with no obstruction on closing the mouth, 
the tooth is ready to be permanently fixed in its place; but 
before proceeding to establish it firmly on its pivot, an instru- 
ment may in some cases be employed with advantage to cut 
;away the central portions of the root, in order to make a close 
fit of the crown to the stump. 




When the point (a) of this instrument is inserted in tlie ori- 
fice of the root, a rotary motion files away the parts proper to 
he removed in order to perfect fee joint. 

By placing eight ^r ten thicknesses of gold foil between the 
crown and root, the ^fluids of the mouth may be wholly ex- 
cluded. 

13. The pivot which is to sustain the new crown in its posi- 
tion, should be made of the best of hickory, as no other wood 
proper to the American soil possesses so much strength and 
elasticity combined. Force the pivot, when properly rounded 
and smoothed with a file, into the orifice of the artificial crown, 
and cut the part of the pivot which projects from the crown to 
such length as the orifice in the root will admit; after which 
the size of the projecting portion of the pivot must be adjusted 
io the orifice of the fang. The force used to insert the pivot 



220 



maury's dental art. 



in the root need not be great, inasmuch as the swelling of the 
wood, when saturated with moisture and heated to the tempera- 
ture of the body, will secure it firmly in its place. The follow- 
ing are a front and a lateral view of a crown when thus prepared 
for insertion. 



V 




14. In some instances the cavity in the natural root has be- 
come, by decay, too large for a pivot of the description just 
given, in which case pivots of gold or platina of a square or flat 
form made jagged at the corners;, must be substituted for the 
hickory, as follows: First fill the enlarged orifice of the root 
with a plug of soft wood, which must be trimmed neatly to 
correspond with the end of the fang. Then insert a similar 
plug into the mineral crown, into which plug screw the end of 
the metallic pivot after it has been passed through one or more 
of the holes of the following screw plate. 




It will be evident that the metallic pivot just described will 
be round at one end and square or flat at the other^ thus: 

The end {a) is inserted into the natural root, and the end 
(6) into the artificial crown. 

15. The final adjustment of teeth set in either of the methods 
just described, may be effected by the aid of a wooden instru- 
ment somewhat of the form which follows, and should be made 
of very tough and soft wood. 



MECHANICAL DENTISTRY. 




If the strength of the hand should be found insufficient to 
force the pivot perfectly into its place, a slight blow on the end 
of the wood, when placed upon the end of the tooth, will com- 
plete the operation. 

16. It sometimes happens that the position of the root is 
such that a crown placed upon it as above described, will not 
occupy the desired position in the mouth, being too far back 
or forward, or having too great a lateral inclination to the right 
or left In these circumstances an entirely new course must 
be pursued; another kind of mineral crown must be procured, 
known as a plate tooth, in contradistinction to the former kind 
called a pivot tooth. The plate teeth are capable of being 
attached firmly to a metallic plate, and as gold is by far the 
best metal for this purpose, I shall denominate it, throughout 
this treatise, a gold plate. 

In a case requiring to be treated in this manner in conse- 
quence of some unnatural condition of the root or of the ad- 
joining teeth, after filing and preparing the root exactly as 
before, take common bees-wax and bring it to a pliable consis- 
tency by steeping it for a few minutes in warm water. When 
in the state of stiff dough or putty, place the wax in a frame 
made of tin, German silver, or other convenient metal, con- 
formed to the arch of the jaw, as follows: 




Of these frames the operator should be provided with various 
forms and sizes to suit mouths of different dimensions. 

17. When a frame of the proper size and curvature has been 
filled with the softened wax, insert it cautiously into the mouth 

19* 



222 



maury's dental art. 



of the patient, and press the wax gently but effectually against 
the cutting edges of the teeth adjacent to the space to be filled, 
until the teeth and gums are completely imbedded in the wax, 
which should be pressed against the gums both inside and out, 
by the thumb and fingers of the operator, holding the frame 
firmly in its proper position with the other hand. The frame 
and wax are next to be cautiously withdrawn from the mouth, 
in such manner as not to mar in the least the impression thus 
obtained. Let the wax cool, and then oil it with a soft brush 
and olive oil slightly; after which thrust a common pin or a 
small wire into the centre of each cavity made by the teeth in 
the wax, in order to render the plaster-cast taken from the 
wax less liable to injury. 

Surround the wax thus prepared with a riband of paper two 
inches in width, secured to the wax by pins or twine, and then 
set the whole in a vessel of sand, which will secure the paper 
in its place. 

18. Take calcined plaster of Paris or gypsum, ground and 
sifted, and mix with it a sufiicient quantity of water to reduce 
it to creamy paste, the exact consistency of which is best de- 
termined by taking in a small vessel as much water as would 
nearly fill the wax mould and the paper rim, and dropping into 
it little by little as much superfine plaster as shall just absorb 
all the water, then stir the mixture for a moment and turn it 
into the mould. 

After fifteen or twenty minutes, as must be determined by 
the quality of the plaster, and the lapse of time since its calci- 
nation, the paper may be removed, and the wax together with 
the plaster-cast immersed in warm water until they can be se- 
parated with ease and safety. Trim the cast with a sharp 
knife, being careful to give the whole such a form as will be 
easily withdrawn from the metal which is to be cast upon it. 
Dry the plaster thoroughly, and it is ready for use. 

It is always best and sometimes necessary to take two si- 
milar casts in the manner just described, for distinct purposes, 
as will be seen hereafter. 

19. Some good artificial workmen take their metallic cast- 
ings in sand, after the manner of brass and iron founders, but I 



MECHANICAL DENTISTRT. 



223 



have found the following process to be much more direct and 
explicit, and every way successful. Take an iron ladle of 
hemispheric shape, and capable of holding at least a pint and a 
half of fluid 5 melt in it as much lead as will nearly fill the ladle. 
Into this molten lead immerse one of the plaster-casts, and de- 
press it by laying weights upon it till the points of the teeth 
shall be sunk about one inch below the surface of the melted 
lead in the ladle. When cool, immerse the whole in water, 
and carefully remove and wash away the plaster. Cover the 
surface of the lead with w^hich the other metal is to come in 
contact, either with the smoke of a lamp, or with whiting laid 
on wet with a brush, in order to prevent the adhesion of the 
melted tin which is to be poured into it. 

Dry the leaden mould well, and place it on a vessel filled 
with water or wet sand, so that the lead shall be sunk in the 
water or sand about an inch, to prevent its fusion when the tin 
shall be poured into it. Surround the impression of the teeth 
in the mould with a ring of tin, copper, or brass, an inch or 
more in width, as in the following cut: 




(a) Denotes the metal ring, (b) Denotes the leaden mould, 
(c) Denotes the vessel with water or sand. 

Fill the ring (a) with melted tin just at the point of fusion, 
or at such a temperature that it will not char dry pine chips or 
shavings; at any temperature higher than this there will be 
danger of fusing the lead, and thus of uniting the metals into 
one mass. But inasmuch as the tin fuses at a lower heat than 
lead, and as the cold water or wet sand will maintain the low 
temperature of the lead, there will be no danger of spoiling 
the cast, in case the foregoing rules are carefully regarded. 
The two metals when cool must be separated by means of a 
heavy hammer, assisted when necessary with wedges of iron. 
The two parts of the mould are now ready for use. Experi- 



224 



mauky's dental art. 



ence will soon instruct the beginner so to trim the plaster-cast, 
as that the tin may be withdrawn easily from the lead. 

20. The operator is now provided with metallic casts similar 
to those which he will be frequently called upon to take in 
the exercise of his art, and between which his plate is to be 
struck. 

Let him then in the next place, cut a piece of gold plate of the 
thickness of a smooth shilling into such shape as exactly to oc- 
cupy the space on the tin cast in which the tooth is to be in- 
serted. When the gold plate is adjusted in its position, and 
bent by the aid of a hammer or pair of pliers nearly into the 
shape desired, bring the tin and lead casts together upon it 
and with a smart blow with a heavy sledge-hammer, force the 
two metals into close contact, by which means the gold plate 
is wedged into the exact shape of the parts to which it is to be 
applied. 

This latter operation is sometimes performed by means of a 
powerful vice, which perhaps effects the object with equal cer- 
tainty. 

21. Separate the casts once more, and place the gold plate 
on the second plaster-cast, which has been reserved for this 
part of the process. If the casts were equally perfect, the plate 
will fit the plaster-casts as it did the tin; and perhaps I may as 
well mention it here as any where, that if the operator wishes 
his plaster-cast to be clean and hard, it should be made warm 
and smeared with two or three coats of boiled linseed oil, ap- 
plied in quick succession by means of a common paint brush, 
and then suffered to dry. 

22. A plate tooth must now be selected of proper colour, 
form and size, and having platina pivots inserted during the 
process of its manufacture to attach it to the plate. At this 
point the operator finds the necessity for two implements of 
the description following: 



I 



MECHANICAL DENTlSTJir. 225 




The shears (a) must be strong; and the plate-punch (b) of 
sufficient material to sustain the force required to perforate the 
plate without springing or breaking. With the use 
of these instruments together with a half round file, 
cut a plate of gold nearly as large as the back surface 
of the tooth; punch the holes as required, and insert 
the pivots as in the cut. 
23. The process of soldering the tooth to the plate, must 
now be understood. To this end, procure a soldering lamp of 
something like the following form. 




The orifice of the spout into which the wick is inserted, 
should be at least three-fourths of an inch in diameter, and the 
vessel capable of containing a quart or more of oil. 

24. A large blowpipe sixteen inches in length must next be 
procured, having a large orifice, and yet capable of bringing a 
jet of flame to an exact focus when required. The long blow- 
pipe prevents a too great exposure of the eyes of the operator, 
and a pair of green glass goggles contribute to the same de- 
sirable result. Before lighting the lamp, cover the surface of 
the tooth on every side excepting that on which the plate is 
fixed, with a coating of plaster or Spanish white and watery 




226 



MAURY'S DENTAL ART. 



and when time will permit suffer the coating to dry before ex- 
posing it to the blowpipe. 

25. The surface of the gold plate, already slightly riveted 
to the tooth, must be washed with a solution of borax (subbo- 
rate of soda) ground with clean water, and laid on with a 
camel's hair brush, and care must be taken that every part of 
the work, where it is desired that the solder should take effect, 
should be touched with the solution. The best surface on 
which to grind or rub the borax is a common slate, such as 
children use at school. 

The solder employed with plate twenty carats fine, may be 
prepared as follows: To one English sovereign or half an 
American eagle, add eighty grains of silver and forty grains of 
copper. Melt once with borax. In order to fit it for conve- 
nient use, it should be rolled into thin plate and well cleaned. 

26. As some students may desire to understand the process 
of manufacturing their own plate in cases of necessity; Take 
an English guinea or sovereign, or an American half eagle, and 
alloy it with an American five cent piece of silver, which will 
reduce it to something less than twenty carat gold. Melt the 
two metals in a crucible with a small lump of borax and when 
cast into an ingot, hammer and roll for use. After being rolled 
the plate should be annealed by heating it to redness; and then 
cleaned by boiling in sulphuric acid diluted with water. 

27. The foregoing hints are deemed sufficient to guide the 
student in the preparation of his own solder and plate when 
compelled to prepare them for himself ; but as a rolling mill 
and other implements are necessary to this course, dentists ge- 
nerally procure their plate and solder ready prepared. 

28. In submitting a piece of work to the action of the blow- 
pipe, a piece of charcoal, cork or pumice stone is used to sus- 
tain the work and confine the heat. Charcoal is most readily 
obtained in masses of convenient size, but a large and flat piece 
of cork, or a block of pumice stone answers nearly the same 
purpose, and on some accounts are frequently preferred. When 
soldering whole sets of teeth or large pieces, a round block of 
charcoal four inches in diameter and six inches in length, hol- 
lowed in the form of a mortar, and having the outer surface 



MECHANICAL DENTISTRY. 



227 



covered with plaster laid on smoothly with a knife or trowel, 
will be found very useful and durable. 

29. When first bringing the flame of the soldering lamp upon 
a mineral tooth under the blowpipe, care must be taken to raise 
the heat slowly, lest a too sudden expansion of the surface of 
the enamel should crack it, and render the tooth useless; and 
a similar caution should be used when cooling the teeth after 
the operation of soldering has been completed. 

30. The skilful use of the blowpipe requires that a constant 
blast should be given till the solder fuses; or at any rate the 
interruptions should be few as possible. To this end the ope- 
rator must acquire the habit of breathing through his nostrils, 
while a stream of air is constantly projected from the blow- 
pipe by the action of the muscles of the cheeks, which may 
be made to expel a current of air from the mouth even during 
the act of inhalation through the nostrils. This process re- 
quires some practice, but may be effectually acquired by de- 
termined perseverance: without it the process of soldering can 
be but imperfectly effected. 

Doctor Black's self-acting blowpipe, in which the burning 
steam of alcohol is used instead of oil, may be managed suc- 
cessfully by a careful workman after a little practice; but the 
heat being very powerful, exposes the gold to fusion. For ge- 
neral use the soldering lamp just described will be found the 
most safely available to the mechanical dentist. 

31. When the piece to be soldered has been brought to red- 
ness, the operator should watch the progress of his work care- 
fully so as to be ready to remove the piece from the flame the 
moment the solder fuses and spreads as desired over the surface 
of the gold. This should be done for two reasons: first, that 
the plate itself may not be melted as well as the solder; and 
secondly, that the solder may not be too much dissipated by 
an excess of heat. The great art of soldering consists in know- 
ing just the quantity of flame proper to be used in a given 
case, and the exact point of time when the heat should be 
withdrawn. 

After the piece has become entirely cool, it may be placed 
in an earthen vessel containing equal parts of water and sul- 
phuric acid. Indeed any simple acid may be used with safety 



228 



maury's dental art. 



and success, taking care that nitric and muriatic acid be not 
used together; for this mixture constitutes the aquaregia, which 
is the only sure solvent of gold. 

The action of the diluted acid will be accelerated by heat, 
which requires a copper vessel: but if the water has been re- 
cently mixed with the acid, sufficient heat will be evolved by 
the chemical union of the two fluids, to accomplish the purpose 
of cleaning the gold in a few moments. 

32. The surface of the solder may now be rendered smooth 
by the use of files, when the tooth and its plate will be ready 
to be united; but before this is done, a gold or platina pivot 
must be inserted in that precise point of the plate which cor- 
responds with the orifice in the root of the tooth, and this pivot 
should be square or flat as described in section 14. When this 
pivot has been soldered into the plate so that it will exactly 
fit its place in the mouth, adjust the plate to the second plaster- 
cast, so that it will fit it as it does the place in the mouth where 
it is to be permanently worn. Then with files and the grinding 
apparatus fit the tooth to the plate, and give it the exact po- 
sition desired as regards the adjacent teeth, and those in the 
opposite jaw. Support the tooth when rightly adjusted, by 
means of plaster of Paris mixed with equal parts of common 
sand, and applied in a state of paste to the surface of the tooth 
and the adjacent parts of the plaster-casts. The sand has the 
efiect of preserving the plaster from cracking when heated by 
the blowpipe. 

33. The piece is now ready when well dried for its final 
soldering; and as a great quantity of heat will be required to 
bring the plaster-cast to the temperature necessary for fusing 
the solder, the whole may be heated to redness in a ladle over 
a fire; or the concave piece of coal before described may be 
used for confining the blast of the blowpipe. 

34. Use a liberal quantity of solder in joining the backs of 
the teeth to the principal plate, in order to give both strength 
and beauty to the work. 

Indeed this is a part of the work which should never give 
way, because there is always room in this sharp angle to use a 
quantity of material which shall secure it from fracture. 

35. If the work has been properly conducted thus far, all 



MECHANICAL DENTISTRY. 



229 



that part of the plate not covering the end of the natural root, 
and connecting with the tooth, may be filed away; and then 
the whole should be polished on a lathe similar to that which 
has been described as a grinding apparatus in section 8, by means 
of a brush wheel, as follows: 




Common sand, ground pumice stone, emery, the debris of a 
grindstone, or crocus, may be used on the brush with water, 
and the final polish may be given with a similar circular brush 
and dry whiting. 

36. In case the tooth requires to be set farther forward than 
could be done on a wooden pivot, the piece constructed as al- 
ready described, will have the following appearances when 
viewed laterally and from behind. 




When the pivot requires to be placed on one side of the 
centre of the tooth, it may assume the following appearance. 




As metallic pivots are liable to work loose when inserted 
in the naked bone of the root, a covering of floss silk or even 
20 



230- maury's dental art. 

of raw cotton wound upon the pivot, will have the effect of 
preventing the friction of the bony structure. Or in some in- 
stances, when the size of the root will allow it, a plug of soft 
wood may be first inserted, into which the metal pivot may be 
gently driven. 

In concluding my directions for inserting a single mineral 
tooth upon a natural root, it becomes necessary to apprize the 
student of the propriety of so placing and shaping the arti- 
ficial crown, that it may not come in contact with the teeth 
of the opposing jaw, inasmuch as constant agitation would 
soon either break or loosen the pivot, and thus render the wor^ 
useless. 



CHAPTER II. 

Of the Insertion of several Teeth on natural Roots, in cases whei-e 
the number of natural Roots does not equal the number of Teeth 
to be inserted. 

37. It sometimes happens that several good roots remain in 
the mouth, fit to sustain artificial crowns, but that some one or 
more roots have been removed either from between or near the 
others, so that a complete arrangement cannot be effected on 
the principles laid down in the first chapter. 



MECHANICAL DENTISTRY. 231 



38. Let it be supposed that the crowns of the four upper 
incisores, and the two cuspidati, are lost, and also the roots of 
the right cuspidatus and left lateral incisor : as in the preceding 
cut. 

In this ease, although the four remaining roots would sustain 
four separate crowns independent of each other, yet there would 
still be two vacancies which are to be supplied; and though in 
the case supposed in the cut, there are back teeth which might 
be used to sustain a plate, with clasps, yet the patient might 
not consent to the use of them; and cases moreover often occur 
in which there are no back teeth in the mouth, leaving it im- 
perative on the dentist to sustain the six front teeth on four 
roots, as in the cut. 

39. Take a wax impression of the front part of the mouth, 
embracing at least the entire space to be supplied with teeth, as 
described in sections 16 and 17, from which proceed to obtain 
metallic casts, as explained in sections IS and 19. To that part 
of the tin cast representing the space to be occupied with arti- 
ficial teeth, fit a plate of tin or lead rolled to the thickness of 
drawing paper, so that it shall cover the ends of the roots to- 
gether with the space left by the two teeth that have been ex- 
tracted, extending back into the mouth three-fourths of an inch, 
and passing behind the first bicuspides on each side of the 
mouth. Bring the two casts together upon the soft metallic 
plate, and then trin^ it to the following shape. 




a is the front part covering the roots; b the back part extend- 
ing to the roof of the mouth or palate; c and d are points of 
the plate which serve to retain it in its place while struck be- 
tween the easts, but are afterwards cut away in case they are 
too much in sight; e and/ are points extending behind the first 
bicuspides, which serve to sustain the piece steadily in its 
place ; and especially prevent the whole apparatus from being 
pushed forward by the action of food, the tongue, or the an 
tagonizing teeth. 



232 



maurt's dental art. 



40. Reduce the soft metallic plate to a plane surface under a 
planishing hammer, and employ it as a pattern by which to 
cut the gold plate, which must be struck between the casts as 
explained in sec. 20. In swedging large plates which are to be 
much bent between the casts, care must be taken to anneal the 
gold plate once or twice during the operation, which is done by 
simply heating it to redness either under the blowpipe, or in a 
coal fire, care being taken that the gold be not melted by ex- 
cessive heat. The following instrument will be found very 
useful in bending gold plates into a shape approaching that 
given by the casts, in order to allow the casts to be brought 
together properly. 



O 



41. Pierce the gold plate with small pivot holes by means 
of the plate punch shown in section 22, exactly over the ner- 
vous orifices in the roots, into which solder pivots of gold or 
platina of the size of a small knitting needle, and one-fourth of 
an inch in length; after which clean the plate, file it smooth, 
and cut off the corners c and d of the plate, if the case requires 
it. 

The plate and pivots will now assume the following appear- 
ance. 




Adjust this plate to a plaster-cast which has been reserved 
for this purpose, in order that the artificial teeth may be ground 




MECHANICAL BENTISTliY. 



233 



and adjusted to the plate just as it is desired they should stand 
in the mouth. To this end support the teeth in their just po- 
sition, by means of softened bees-wax placed behind them on 
the plate to which it may be made to adhere by warming the 
plate. 

If the patient can be seen at this stage of the process, instead 
• of fitting the teeth as just described, according to the best judg- 
ment of the operator, cover the plate with softened wax, which 
place in the mouth, and bring the ends of the teeth of the 
lower jaw against the wax till the mouth is shut in its natural 
position. The impression of the antagonizing teeth in the 
wax, will be a sure indication of the just position of the artifi- 
cial substitutes. The wax may be cut away with a penknife 
as each tooth is adjusted in its place. 

If, on the other hand, the operator finds it necessary to fit 
his teeth to their place before seeing his patient, the whole 
may be tried into the mouth, by proper care; or if sealing-wax 
be used instead of bees-wax, the trial will be attended with no 
difficulty. 

42. When the mineral teeth have been set in the position re- 
quired, and ground at the butts so as to fit the plate accurately? 
and project beyond it in order to touch and even press upon 
the gum, cover the enamelled faces of the teeth, with a mixture 
of plaster and sand in equal parts reduced to a paste with 
water. This mixture is little liable to crack under the heat of 
the blowpipe, especially if secured by a few turns of fine iron 
wire, such as dentists frequently need in various parts of their 
work. This wire is little thicker than a bristle or coarse hair, 
and is so soft and pliable as to be little liable to break. 

Remove the bees-wax from behind the teeth, which may be 
effected with a penknife, or by the aid of warm water. 

43. Each tooth may now be removed from its place, and a 
gold back or stud may be fitted to it as described in section 
22. Care should be taken that the gold back be fitted closely 
not only to the tooth but to the plate, and if, by accident, the 
junction with the plate should be imperfect, the vacancy may 
be filled with gold foil carefully introduced so as not to change 
the position of the tooth. Over this foil the solder willfollow, 
and even incorporate itself with the foil, uniting the whole into 

20* 



234 



maury's dental art. 



one solid mass, especially if a sufficient quantity of solder be 
employed. When each tooth has its gold back thus properly 
adjusted, the whole piece will have the following appearance 
as seen from behind. 




44. When the plaster has been thoroughly dried, which may 
be done in an oven, provided the operator be in haste, or over 
a fire in a ladle, provided the degree of heat used be not suffi- 
cient to recalcine the plaster, the piece is ready to be soldered. 

In order to perform the operation of soldering with neatness, 
solidity and beauty, apply the borax to the back of the tooth 
only, quite down to the plate, by means of a flat, thin piece of 
cane or soft wood. A sufficient quantity of the borax will run 
down upon the plate without applying any to that, and if the 
operator has any fear that the borax will carry the solder over 
too great a portion of the plate, he may apply a thin coating of 
whiting to all that part to which he wishes no solder to run, 
leaving in all cases a semicircular spot behind each tooth, 
which must be kept quite clean in order that the solder may 
run over it unobstructed. Next, apply a quantity of solder to 
the back of each tooth, nearly or quite equal to the weight of 
the back itself. This may be in one or several pieces, at the 
pleasure of the operator. Let the borax dry, if time will 
permit, lest it should displace the solder during the sudden 
conversion of the water into steam by too great a degree of 
heat. 

45. Before applying the blowpipe to a piece like this, the 
hollow cup of charcoal mentioned in the first chapter should 
be prepared as follows: — 



MECHANICAL DENTISTRY. 



235 




Let the operator not forget to apply the heat with caution, 
lest the teeth be cracked by sudden and unequal expansion, and 
let the heat be continued until the solder assumes the form best 
calculated to give strength and beauty to the work. This form 
which the solder should assume, may be thus presented on a 
single tooth when seen laterally with a section of the plate. 




Should the quantity of solder on any tooth be found insuffi- 
cient, more may be added during the process of soldering, and 
the heat again raised to the point effusion. 

In soldering pieces like this, some advantage would be 
gained, if the right hand of the operator could be at liberty to 
make use of a rod of platina of the size and length of a knit- 
ting needle, with which he may move the melted solder about 
on the gold plate at pleasure, in order to bring it into the de- 
sired form. 



236 



maury's dental art. 



To accomplish this object, it will be necessary to use one of 
Hook's self-acting blowpipes, which, with an improvement 
made by Dr. Jahial Parmly, of Bond Street, New York, will 
be found of great importance to the mechanical dentist. 

This blowpipe, as is w^ell known, consists of a brass globe 
composed of two hemispheres screwed firmly together, having 
an orifice at the top for the purpose of introducing alcohol, and 
a tube leading from the upper hemisphere to the flame of a 
lamp placed underneath the brass sphere. The whole may be 
supported on a stand as follows: — 




Without entering more minutely into the details of the for- 
mation of this instrument, I will merely add, that when the 
globe is partly filled with alcohol, and the lamp lighted be- 
neath it, a part of the alcohol is soon converted into vapour, 
which finding no vent excepting through the small tube lead- 
ing to the upper hemisphere of the brass globe, the vapour or 
steam of the alcohol is forced from the orifice of the tube di- 
rectly against the flame of the lamp by which the alcoholic steam 
itself takes fire and forms a jet of flame of great intensity. Dr. 
Parmly's improvement consists in having two distinct wicks in 
the lamp with their appropriate tubes, so that one may act on the 
globe while the other is wholly diverted from it, or both may 
be directed upon the piece to be soldered when that may be 



MECHANICAL DENTISTRY. 



237 



necessary. With this instrument Dr. Parmly has succeeded in 
preserving the solder in a state of fusion for any required 
time, while with his platina rod he has given to the solder the 
form and position required, and all this without raising tempe- 
rature enough to fuse the gold plate. 

When the piece in question has been properly soldered, 
cleaned and polished as already described, the pivots may be 
wound with a little raw cotton, or floss silk, before fixing the 
plate firmly in the mouth, in order to avoid the wearing away 
of the roots by the metal; or when the cavities in the roots 
are very large, they may be filled with soft wood, and the pi- 
vots inserted into these wooden plugs. 

Of the Insertion of a single Tooth in the Absence of a natural Root. 

46. This is so nice and difficult an operation that I shall 
deem it expedient to present several examples, inasmuch as 
we find that many dentists who can construct a good double 
set — rarely ever succeed in setting a single tooth well. 

Let us first suppose that the tooth to be supplied is a central 
incisor of the upper jaw; and that it is intended rather for 
show than mastication, inasmuch as the patient is unwilling to 
submit to an arrangement that would render the artificial sub- 
stitute fit for general use. 

After fitting a gold plate to the space to be occupied by the 
tooth, as already directed, solder a wire of fine gold or platina 
to each end of the plate, of sufiicient length to embrace the 
two adjacent teeth as far as those next to them will permit, as 
follows; 




Such a plate with its clasps of wire, when well fitted to the 
gum and the two adjacent teeth, is found to sustain a tooth in 
its place with sufficient firmness for all purposes excepting that 



238 



maury's dental art. 



of masticating food; but if a tooth be desired for the perform- 
ance of this latter function, another plan must be pursued. 

Select two of the molares or bicuspides, one on each side of 
the mouth, around which clasps of gold may be adjusted, either 
with or without filing a passage for the clasps, as circumstan- 
ces may require. To these clasps attach the extremities of a 
plate constructed as already described, and sustaining the tooth 
as follows: 




As the best methods of attaching a clasp to a plate in a neat 
manner, are of some importance to the student, I may state 
that winding with fine iron wire will sometimes succeed, yet 
the following mode is always most efficient and exact. The 
clasp which in most cases should be as wide as the tooth it 
embraces will admit, may be secured to the gold plate while 
both are on the model, by joining them with bees-wax, or, when 
necessary with sealing-wax. Then lift the whole carefully 
from the model, lay it on a piece of paper with the side on 
which the wax is downward, and pour plaster upon the upper 
side until both the clasps and plate are imbedded in the plaster. 
When the plaster is set, remove the wax, dry the plaster, ap- 
ply the borax, and solder as usual. 

In this as in all other cases when two pieces of gold plate 
are to be united with solder, if the two do not accurately meet, 
fill up the vacancy with gold foil before applying the borax 
and solder, as already directed. 

This method of insertion, although more expensive than with 
one clasp only, has the advantage of greater firmness and dura- 
bility. 

The disadvantages of such a plate and clasps, are, the injury 
accruing by necessity to the teeth which are embraced by the 
clasps, and the inconvenience experienced by the tongue from 



MECHANICAL DENTISTRY. 



239 



the presence of a plate in the front of the mouth, which the 
tongue meets in articulating all the lingual sounds. Both these 
disadvantages, however, are generally preferred to the absence 
of a tooth from the front of the mouth. 

In cases like the foregoing, for the purpose of preparing a 
metallic cast in such a manner that the gold plate struck upon 
it shall fit accurately to the natural teeth behind which it 
passes, cut away from the plaster model all the teeth nearly 
level with the gum, then after taking the metallic casts from 
this, strike the gold plate over the whole, and cut away the 
plate accurately with round files, where the natural teeth are 
to meet the plate. 

47. It happens not unfrequently that, either on account of 
the loss of the teeth on one side of the mouth, or for some 
other solid reason, an attachment can be made to only one tooth, 
or to those on but one side of the jaw. In the former case a 
piece may be constructed as follows: 




If the plate and spring, or clasp, are of considerable thick- 
ness and strength, this arrangement will be successful, even for 
purposes of mastication, but it is desirable in many cases, if 
practicable, to take two points of support, as follows: 



240 



maury's dental art. 




In all cases the clasps embracing natural teeth for the pur- 
pose of supporting artificial ones, should be as wide as possible, 
in order to avoid wearing away the teeth at the neck. 

48. Let us next suppose that the second bicuspis has been 
removed, and the dentist is required to supply its place. The 
object in this and all other cases, being to throw the fastenings 
as far back into the mouth as possible, in order to be out of 
sight, let the clasp embrace one side of the first molaris, and 
both sides of the second, thus: 




This method of fixing will prove very firm, provided the 
strength of the materials be justly proportioned to the use to 
which the artificial substitute is to be applied. 

In those cases where the next tooth is the only one to which 
attachment can be made, it must be evident that no great de- 
pendence can be placed on the firmness of the work. If, how- 
ever, the tooth which is to sustain the piece be either very flat 
like some bicuspides, or very strong and angular like some mo- 



MECHANICAL DENTISTRY. 



241 



lars, the work will not fail to be of use. Take, for example, a 
first bicuspis and a first molaris. 





In the former case, if the second bicuspis be very flat, the 
clasp will be little liable to a rotary motion. In the case of a 
first molaris, when the second is strong and angular, the most 
perfect success will attend the operation. In both these cases 
the strength of the material, together with the peculiar form 
of the supporting tooth, will secure the piece from being dis- 
placed by any other means than hard food, which must not be 
allowed to come in violent contact with so slight a fixture. 



Of the Insertion of several Teeth on a Gold Plate with Clasps 
sustained by natural Teeth. 

49. As cases of this description are very various, and not 
less in number than the arithmetical changes that can be rung 
on 32 bells, I shall deem it necessary to give only a few ex- 
amples as specimens of the whole: and I begin with the most 
common and most important case of this kind, which presents 
itself in supplying the two central superior incisores. 

Although there can be little doubt of the superior perma- 
nence and utility of a plate of this kind attached to some of 
the back teeth, thus: — 




21 



242 



maury's dental art. 



Yet many American dentists and most of the English practi- 
tioners would treat the case as follows: 



Here the whole apparatus is secured in position by means 
of two small gold wires encompassing in part the lateral in- 
cisores. Some assistance, however, is rendered by the narrow 
neckings on that part of the plate which is adjacent to the 
neighbouring teeth. These neckings must fit with great exact- 
ness or they cannot be endured by the tongue. Pieces like 
these are less liable, perhaps, than some others to affect injurious- 
ly the natural teeth : which is certainly a great argument in 
their favour. 

50. Sometimes when even four of the incisores are to be sup- 
plied, the same principle is successfully observed, thus: 



But in almost all cases of this kind, I should prefer an at- 
tachment to some of the back teeth when practicable, as fol- 
lows: 





MECHANICAL PENTISTRY. 



243 



If two bicuspides are to be supplied, as is not unfrequently 
the case, let the following be a sample: 




51. In cases where several teeth must be supplied, and only 
a few remain to sustain them, various mechanical contrivances 
become necessary to solve the problem with success. 

Suppose, for example, that the two first molars are the only 
remaining natural teeth. It will be evident that the weight of 
a plate bearing the ten anterior teeth, would soon cause the two 
supporting teeth to swerve from their rectitude, and allow the 
front teeth to fall away from the gum. 

In order to avoid this catastrophe, the plate must be extended 
as far as possible behind the supporting molars, in order to find 
a fulcrum or sustaining point to the lever here represented by 
the gold plate. 




These extremities of the plate may be used to sustain ar- 
tificial teeth, or they may be left unoccupied, but their pre- 
sence is essential to the proper construction of the piece, in- 
asmuch as the two supporting molars must be drawn per- 
pendicularly from their sockets before the front can fall in 



244 



maury's dental art. 



consequence of their motion; whereas a mere lateral decli- 
nation of these supporters would produce that effect in the 
absence of these extremities of the plate behind the two na- 
tural molars. 

52. One of the most vexatious cases falling into the- hands of 
the dentist, is that in which a large plate must be supported by 
a single tooth. 

If this should chance to be a large and firm molaris, the 
chances of success are somewhat enhanced; in which case the 
piece will present the following appearance. 




Cases of this character are so doubtful as to the permanence 
of the supporting tooth, that unless it be very firm and sound, 
it ought not to be trusted. When, however, the attempt is 
made to construct such a piece, let the clasp be very strong and 
the plate thin and light. The teeth also should be as slender 
as possible. 

53. The operator should always avoid laying plates over 
roots of the natural teeth remaining in the mouth. Besides 
the absolute certainty that these roots will prevent the perfect 
fit of the plate to the gum, they are liable to be agitated by 
the constant action of the plate upon them, by which they be- 
come loose, and often require extraction, after which the plate 
no longer fitting the gum, becomes useless. 

Although many patients are very averse to the removal of 
these roots, and often allege examples among their acquaint- 
ances in which plates have been laid over the roots of the 
natural teeth, with perfect success, cases rarely occur in which 



MECHANICAL DENTISTRY. 



245 



these persons cannot be persuaded to pursue a proper course of 
treatment, by judicious management on the part of the dentist. 
Sometimes he may succeed in inducing them to submit to the 
operation of extraction, by showing them that their money will 
be wastefully expended in procuring work which rests upon a 
foundation insufficient and precarious; at other times, by as- 
suring them that he is wholly averse to executing work unless 
he can do it in what he knows to be a proper manner, by which 
he can do justice both to his patient and his own professional 
reputation. Often he may succeed in his object by persuading 
the patient to permit him to remove one or two only of the 
loosest of the roots, after which, the charm being broken, no 
resistance will be made to the. extraction of the rest. 

At any rate, if the operator consents, in any instance, to 
lay a plate over the stumps of teeth, he owes it to himself 
to impress it on the memory of his patient that he does it 
in opposition to his judgment and experience, and does not 
consent to hold himself responsible for the result. If this 
statement should be entered on his books, with the patient's 
knowledge, it might prevent future complaints, for it happens 
not unfrequently that a dentist in extensive practice is blamed 
for operations, the failure of which is the result of the obstinacy 
of his employer. 

54. Another precaution of which the young practitioner 
should be early apprized, is, never to lay a plate after teeth or 
roots have been extracted, until sufficient time has elapsed to 
allow the alveolar processes to be absorbed, and the gums 
fully healed, so that the teeth shall not become too short by 
subsequent absorption of the subjacent parts. 

The dentist who neglects this precaution, will find himself 
frequently called on to substitute longer teeth, and will even 
sometimes be assured that they have been always too short 
from the beginning. 

55. To avoid these unpleasant occurrences, let him, on the 
one hand, insist on allowing the gums sufficient time to become 
thoroughly healed and settled before constructing his work, 
and, on the other hand, let him never forget to leave the arti- 
ficial teeth as long as circumstances will permit. In many in- 
stances, especially when the artificial substitutes are met on 

21* 



246 



maury's dental art. 



their cutting edges by antagonizing teeth, the latter of these 
injunctions cannot be obeyed, and it is in such cases particu- 
larly, that the dentist should protect himself from both blame 
and loss, by keeping a record of the statements which he made 
to the patient on the subject. 

56. It is very difficult to give any definite rule as to the 
period required for the absorption of the alveolar processes 
and the thorough healing of the gums after the removal of teeth 
or roots. In some cases a week may be sufficient, if only a 
single root, and that a short one, has been removed. A month 
even would be too brief a period for the majority of cases that 
occur in practice, and two or three months are sometimes re- 
quired. Each case is modified so much by the condition of 
the patient's health; by the number and character of the teeth 
extracted ; and by the state of the natural teeth remaining in 
the mouth, that the period required in any given set of cir- 
cumstances, is better learned by observation, than taught in 
theory ; and this is one, among many reasons, requiring a pa- 
tient apprenticeship of several years under suitable tuition, in 
order to enter understandingly upon general practice in dental 
surgery. 

57. The dental operator owes it to his patient w^ho has con- 
fided in his skill and integrity, and he owes it to justice and 
humanity, to inform all his professional friends who wear arti- 
ficial teeth on metallic plates, of the great importance of not 
merely putting the moutli in a healthy condition before the 
introduction of artificial substitutes, but of the absolute neces- 
sity of keeping the mouth, and all it contains, perfectly clean 
afterwards. 

Nothing is better established among physiological facts, 
than that filth lodged among the teeth, and left to ferment, 
decompose, and putrefy in the mouth, invariably destroys, 
sooner or later, all the remaining natural teeth; and thus ren- 
ders useless all the clasps and fastenings of which we have 
treated at large in this chapter. 

It may indeed be true that many patients will not comply 
with the instructions of the dentist on this subject, as it is un- 
questionable, that even some females of extreme neatness in 
other things, allow the mouth to be by far the most filthy 
place in all their habitations. They scrub their hearth-stones 



MECHANICAL DENTISTRY. 



247 



and require the chimneys of their houses to be now and then 
swept, but as to their mouths, they have really no time to keep 
them clean. But notwithstanding all this, the dentist who 
introduces artificial teeth, should urge 'the necessity of keeping 
the mouth absolutely clean. 

58. It is known to every dental practitioner that although 
there is no single and simple acid that will corrode or dissolve 
gold, yet there are combinations of acid and other acrid sub- 
stances allowed by some persons who wear metallic plates to 
remain so long and so constant in their mouths, as to destroy 
a thick plate of gold in a very few years. 

This never could occur if the mouth were washed thoroughly 
with water and a brush several times a day; much less, if some 
slightly alkaline solution, or a good dentifrice were occasionally 
employed. 

59. In order to aid the patient as much as possible in this 
duty of keeping the mouth free from impurities, the dentist 
should in ail cases, if not impracticable, so construct his work 
that it may be readily removed from the mouth. 

The springs or clasps which have been already described, 
should be made sufficiently fast to sustain the plate and teeth, 
but at the same time capable of being slipped from the natural 
teeth which they embrace, at the pleasure of the wearer. 

To this end it may be sometimes necessary to restore the 
elasticity of the metal which has been destroyed by the heat 
employed in soldering. This is effected by the strokes of a 
small hammer; and by using a small anvil called a beck-horn, 
it may be done with ease, especially in those parts of the clasp 
where the elastic spring is most required. 

60. This elasticity of the clasp is most required in those 
cases where the neck of the tooth which sustains the plate, is 
considerably smaller than the crown over which the clasp must 
be first passed. I have sometimes been compelled to obviate 
this difficulty by means of an elastic gold ferule made of very 
thin plate and wound in concentric circles in the manner of the 
mainspring of a watch. This should be so constructed that 
when encompassing the neck of the tooth, it shall embrace it 
firmly. Over this the clasp attached to the plate may be readily 
passed, if all parts be properly constructed. 



248 



maury's dental art. 



CHAPTER III. 

Of the Insertion of entire Sets of artificial Teeth, both upper and 
lower, on Plates of Gold, without Clasps or Springs. 

61. It often happens, in this age of luxurious refinement, ef- 
feminate ease, and unnatural alimentation, that persons of both 
sexes, and of all classes of society, lose successively every tooth 
in both jaws; but more frequently in the upper maxillary arch. 
The dental operator who understands his business, although 
he deplores the folly or misfortune of his patient, is never 
more confident of ultimate success than in treating cases of this 
description, when he is permitted to exercise his best judgment 
in the employment of his utmost skill on the most suitable 
materials. As there is no longer a necessity of attaching his 
work to other teeth, which are liable to be soon removed either 
by decay or dislocations, he can construct an entire set of teeth, 
set upon a strong plate of gold, which shall fulfil all the rea- 
sonable expectations of the patient in regard to appearance, 
speech and mastication, and which shall moreover be so dura- 
ble in its character as to render the annual expense of small 
amount for many years to come. 

62. To secure entire success in the fabrication of these en- 
tire sets of artificial teeth, the utmost care must be taken to 
remove all the roots of the natural teeth, and to bring the gums 
and adjacent parts into a perfectly healthy condition. In ordi- 
nary cases, time alone, without any sanatary remedies, will 
effect this object, provided a sufficient period be allowed after 
the removal of the natural roots. Not only must the cavities 
which the roots occupied be wholly filled up, but the alveolar 
processes must be thoroughly absorbed, so that no material 
changes shall occur after the wax impression shall have been 
taken, from which the working models are to be made. 

63. It is impossible to prescribe definite periods for all the 
cases that may occur in a promiscuous practice, during which 
this healing process, together with the absorption of the bone, 



MECHANICAL DENTISTRY. 



249 



will be perfected. Much depends on the age, habits and 
health of the patient, and not a little on the circumstances 
under which the natural teeth are shed. In some subjects, the 
alveoli are nearly or wholly absorbed, before the roots of the 
natural teeth lose their hold upon the integuments: in others, 
several sound teeth are extracted, around which the alveoli 
were perfectly preserved. From all these causes it must be 
evident, that each distinct case possesses an idiosyncrasy of 
character peculiar to itself, and must be treated accordingly. 
It is proper to say here, that a few weeks will be sufficient for 
the preparation of some mouths for taking an impression; 
whereas, months will be required in a majority of instances. 

64. When the operator becomes convinced that the gums 
are well healed and settled, and that no farther changes are to 
be feared, which will endanger the permanent and complete 
success of the operation, he should procure very ample metallic 
cases to contain his wax, so that the impression may extend to 
every part of the maxillary arch on which the plate must rest; 
taking care that the wax shall reach the extremity of either 
jaw towards the angle of articulation, and spread itself over at 
least two-thirds of the palatial concavity, when the upper teeth 
are to be restored, and moreover, that the wax come forward 
on the labial side of the arch as far as the muscles and integu- 
ments will permit. In taking these large impressions, let the 
wax be pure and without any admixture of olive oil, and just 
soft enough to receive the impression without too great pres- 
sure on the parts, and yet not so soft as to be injured while 
withdrawing it from the mouth. The proper consistency of 
the wax and the necessary shape and strength of the metal 
case, which contains it, are of great moment in the attempt to 
secure a satisfactory result; but in this case, as in many others, 
experience is the only competent instructor. 

65. Inasmuch as the pieces which I am now describing, are 
those which by some have been called "suction plates," and by 
others are said to be retained in position by atmospheric pres- 
sure, 1 deem it proper in this place, to express an opinion on 
the subject, resulting not only from conversation with distin- 
guished dentists, but from years of personal experience and 
observation, during which I have had occasion to inspect 



250 



maury's dental art. 



pieces of this description constructed by some of the most dis- 
tinguished artists of both hemispheres. 

66. One result of my inquiry and observation has been, that 
few pieces of this kind are fixed firmly upon the gum, and used 
successfully for purposes of mastication, by mere suction, or 
atmospheric pressure, without any aid from the tongue, lips, 
cheeks, and antagonizing jaw. There is indeed, in favourable 
cases, a very firm adhesion of the plate to the subjacent parts 
after it has been some time worn, and thus closely fitted to the 
gum and palate. But this adhesion, which is that of two well 
adapted surfaces, from between which the atmosphere is ex- 
cluded either by impact, or by liquids, or both combined, 
could never be efiected unless the plate were held firmly in its 
place, for a season, either by the bold relief of the alveolar pro- 
jection, or by the lips, tongue, teeth and opposing jaw; and in 
fact, these surrounding parts — together with the contained 
convexity of the projecting gum, contribute not merely |)ar- 
tially, but mainly, to the preservation of the piece in its just po- 
sition. The manner in which the surrounding parts operate to 
secure such a plate in situ, are too well known to need any 
illustration even to the youngest student of our art; but the 
manner in which the bold bas relief of a prominent alveolar 
projection, may and often does operate to sustain a plate, from 
beneath which the atmosphere has not been excluded, shall be 
explained by a simple diagram. 




Let j5 in the above figure, be a cylinder of wood, metal 
or any other substance, not more yielding than the alveolar 
ridge of the human mouth when denuded of its teeth; and let 
C i) be a plate of metal so bent as to embrace the cylinder firm- 
ly in the parts adjacent to its two straight sides. It is very 
manifest, that such a plate might be sustained very firmly in 
its connexion with the cylinder, even though a stratum of 
air of any supposable thickness, intervened between the cylin- 
der and plate. 

It is indeed quite certain, that the fi^rmness of this adhesion 



MECHANICAL DENTISTRY. 



251 



would be much increased if the cylinder were so fitted to the 
plate, as that the air were wholly excluded, and this only 
proves what I wish to impress strongly on the mind of the 
dental student, that even when all other circumstances are most 
favourable to the success of his operation, the perfect adaptation 
of plates like this to the subjacent parts, is of the utmost im- 
portance. The fact that a perfect jit, as it is called, excludes 
the particles of food, and also renders the plate more tolerable 
to the tongue, would of itself impel every neat and finished 
operator, to give to his plate the best possible adaptation to the 
parts beneath. 

67. Another fact, with which observation has furnished me 
is, that inasmuch as the lips and cheeks contribute greatly to 
the stability of the position of an entire set; the artificial teeth 
should extend as far back as possible on the plate, in order to 
present as large a surface as convenient to the sustaining action 
of the muscles of the cheek. For a similar reason, the portion 
of the gold plate resting upon the palate directly over the 
tongue, in what is vulgarly called the roof of the mouth, should 
be as broad as circumstances will permit, in order that the su- 
perior surface of the tongue may lend its important aid, when 
required, in sustaining the artificial fixture in its place. 

68. Experience and observation teach, moreover, that the 
gold plate must pass upwards as high as the muscles will per- 
mit, on the anterior and outer surface of the gum, between the 
cheeks and the maxillary arch. This not only increases the 
surface, thereby augmenting the force of adhesion, but it assists 
in preventing the plate from moving either laterally or back- 
wards, in the act of mastication. 

69. A proper thickness of the gold plate is matter of pri- 
mary consideration, in these entire sets of teeth; and the thick- 
ness must vary in the direct ratio of the flatness or prominence 
of the alveolar ridge. The rule invariably is, that the plate 
shall be as light as is compatible with the strength required. 
Very flat gums require thicker plates than those which are 
more convex and protuberant, on the simple principle that a 
flat riband of metal of any given breadth and thickness, will 
bend in the direction of its length more readily than the same 
plate bent laterally into the semi-segment of a hollow cylinder. 



252 



maury's dental art. 




If A represent a flat metallic plate of any length and breadth, 
and jB a cylindrical plate of equal dimensions, the strength of 
the latter will be many times greater than that of the former, 
in proportion to the convexity of its curvature. Hence it fol- 
lows that the deeper the convexity of any gold plate for the 
mouth, and the broader its superficial area, the thinner may be 
the plate. And, on the other hand, when the plate is narrow 
and flat, it must be increased in thickness until it shall possess 
sufficient strength to resist the ordinary forces to which it must 
be necessarily subjected. 

70. Since, as we have already said, every plate worn in the 
mouth should be as light as the strength demanded will per- 
mit, we have another among many solid reasons for preferring 
gold to any other metal for setting artificial teeth. Platina 
would resist the action of corrosive agents better than gold, but 
a much greater weight and bulk of this metal would be re- 
quired, to give the strength of a similar gold plate. 

71. The following is a drawing from a cast of one of the 
most prominent gums, to which T have been called upon to ad- 
just a suction plate during the period of my professional prac- 
tice. 



MECHANICAL DENTISTRY. 



253 



The depression at A below the prominence at i5 C D is full 
three-fourths of an inch. To a mouth like this there can be no 
difificulty in adjusting a suction plate with the most perfect suc- 
cess. If the model be correctly taken, the plate rather thin, 
and proportionally broad, it will require no more than ordinary 
mechanical skill to construct a piece which will remain firmly 
in its place, even in the act of masticating the hardest kinds of 
food. 

72. But the ability of such a piece, to sustain the office of an 
implement of mastication, depends greatly on the position of 
the teeth, which are set upon it, and on the manner in which 
they meet those of the lower jaw. If the front incisores should be 
set too far forward on the plate, and if there should be no molar 
teeth in the lower jaw to countervail their action on the lower 
incisores, it will be manifest that the whole will be thrown for- 
ward, in closing the mouth. 




In the cut here given, if we suppose the upper incisores at 
Jl, to strike wholly over and in front of the lower incisores at 
C, inasmuch as there is nothing to sustain the point of the plate 
at B, it will inevitably fall away from the gum, whereupon the 
whole will be projected forward whenever the mouth shall 
close, and render the piece useless. Such an arrangement 
could be made available only by supplying the deficiencies in the 
lower jaw. If this is not done, the front teeth of the artificial piece 
must be removed backward until they strike perpendicularly 
upon the lower incisores, in which case the centre of gravity 
of the artificial piece will, in most instances, be so supported as 
to render the work available for all the important uses to which 
the teeth are usually applied. 

73. After the dental operator has formed his plan as to the 
22 



254 



maurt's dental art. 



position which he wishes the teeth to assume on the plate, and 
also as to the manner in which he intends the substitutes shall 
meet the natural teeth of the lower jaw, the best method of 
proceeding is as follows: After striking the plate as heretofore 
described, and after fitting the gold backs to the teeth which 
have been selected for the purpose, cover the outer surface of 
the plate which may be called the lingual surface, with soft- 
ened bees-wax, equal in thickness to the length of the teeth, 
and adjust the teeth as nearly as possible in the required posi- 
tion, taking care to grind each tooth down to the plate with 
the greatest accuracy, in such manner that the gold back of 
each tooth shall touch the plate. There are some advantages, 
in certain cases, in using sealing-wax instead of bees-wax; in 
thus temporarily attaching the teeth to the plate. When this 
is used the flame of a lamp or candle may be employed to melt 
the wax as it shall be needed for each tooth. 

74. In this stage of the progress, try the whole into the 
mouth of the patient, and correct the position 'of the several 
teeth so that in all respects they shall stand as desired. This 
process of adjusting will be readily effected, while the wax is 
preserved by heat in a softened state. When all the teeth 
stand exactly as all parties desire, remove the whole from the 
mouth carefully, and encompass all the teeth, together with the 
plate, with plaster of paris, leaving the wax uncovered. When 
the plaster shall become thoroughly hard, immerse the whole 
in warm water, in order to soften the wax, or cut it away with 
a penknife, leaving the teeth and plate firmly imbedded in 
the plaster. In this as well as other cases where the plaster 
must be subjected to the action of the blowpipe, sand should be 
mixed with the plaster to prevent its cracking, or if this pre- 
caution should have been neglected, the plaster may be encom- 
passed with a few turns of fine iron wire, as already directed. 

75. After the gold plate and backs of the teeth have been di- 
vested of the wax, they should be well washed in clean water, 
when the piece will be ready for soldering. In large pieces 
like this, where great strength and durability are required, the 
utmost care must be used to employ solder enough not only to 
render the work beautiful, but to give the stability required; 
for, as I have already remarked, a good piece of work never 



MECHANICAL DENTISTRY. 



255 



gives way at the junction of the plate with the backs of the 
teeth, inasmuch as that is by far the strongest part of a good 
piece. In soldering large plates of this sort, the flame of the 
blowpipe should be applied cautiously at first, and afterwards 
augmented gradually till the whole mass is heated to redness; 
after which a concentration of the jet of flame should be 
brought to bear upon the back of each of the teeth successively 
till the solder has all assumed the desired form and position, 
throughout the entire range. After cooling, cleaning, and 
polishing, the piece will be ready for insertion. 

76. As the cleaning and polishing of such large plates, is an 
important operation as regards their beauty, 1 will recapitulate 
the process, and describe it a little more minutely than I have 
yet done. When the piece has been boiled for a few seconds 
in diluted sulphuric acid, or suffered to lie a few minutes in 
diluted muriatic acid, without boiling, let the edge of which 
rests on the palatial arch be a little bent upwards by the use of 
a small riveting hammer, while the plate rests on the end of a 
steel rod half an inch in diameter, rounded at the end in the 
form of a hemisphere. 

The shape of the rod, and the form and size of the hammer, 
are represented in the following wood-cut. 



The sharp and broad edge of the hammer must be applied 
with repeated strokes and a skilful hand to the lingual side of 
the inner edge of the plate until it shall effect the object to the 
extent desired. There is but one method of avoiding the ne- 
cessity of this operation, which is to pare away the plaster cast 
upon which the metal casts are to be made, along the inner edge 
of the plate, so that the plate in being struck between the me- 





256 



maury's dental art. 



tal casts, shall be properly bent upwards without the use of 
the hammer afterwards. This trimming of the cast, however, 
will be more difficult than the method first described, especially 
to the inexperienced. 

77. Let the plate in the next place be filed very smooth, in 
all parts, commencing with coarser gold-files and finishing with 
very fine ones. In the next place, rub the plate smooth with 
a silver-smith's polishing stone, which may be cut with a fine 
saw into any shape desired. After this, use rotten-stone and 
sweet oil, applied with leather attached to the end of a piece 
of soft wood; afterwards apply dry Spanish white, crocus, or 
rouge, and finish by washing in clean water. To those por- 
tions of the plate which cannot be reached with the leather, 
the above-named substances may be applied on threads of silk, 
flax, hemp or cotton. When threads are thus used they may 
be fastened at both ends to some fixed points in the manner of 
the horse-hair of the bow of a violin, and motion may be given 
to the piece along these filaments to which the polishing sub- 
stances have been previously applied. When the whole is 
finished and ready to be inserted in the mouth, it presents the 
following appearance. 



MECHANICAL DENTISTRY. 



257 



78. It sometimes happens that the maxillary ridge is so flat, 
that the action of the lips, cheeks and tongue, together with 
the slight degree of adhesion which takes place when the plate 
is first inserted, are incapable without a little practice of keep- 
ing the piece in its place, whereupon being left to the action of 
gravitation, it falls whenever the mouth is opened. To remedy 
this difficulty, which is removed by a little experience, and 
which is felt less and less as the gum becomes adapted to the 
plate, it is sometimes necessary to wear a piece of soft leather, 
either that of the chamois goat, or well-dressed lamb-skin, cut 
to the exact size of the gold plate, and moistened with water. 
By this means the adhesion is promoted to such a degi^ee, that 
the piece may be worn with little comparative difficulty. It is 
often true, in the case of aged persons, that the alveolar pro- 
cesses become so completely absorbed, and the parts upon 
which the plate must rest, so nearly flat, that the difficulty of 
wearing a suction plate is greatly increased. In such cases the 
use of springs must be adopted, such as will be hereafter de- 
scribed, or the patient must dispense with artificial teeth al- 
together. 

79. As the foregoing description of a suction plate, is appli- 
cable only to the upper jaw, inasmuch as the principle of co- 
hesive attraction or atmospheric pressure, does not apply to 
any great extent, to plates worn upon the narrow alveolar ridge 
of the lower jaw, it may be proper here to remark, that the 
attraction of gravitation necessarily operates in some degree 
to counterbalance this defect in the lower plates. These pieces 
will of course remain in their places by gravitation alone, pro- 
vided the food, the tongue, the lips, and the cheeks do not dis- 
place them. But all these causes are so apt to render lower 
plates useless without some artificial means to keep them in 
position, that I shall deem it necessary to employ springs in 
most instances; but as there are a few cases in which under 
pieces can be worn without springs, I shall present a drawing 
of one of them as follows: 

22* 



258 



maury's dental art. 




80. In these plates for the under jaw, the whole process of 
construction, will be similar to that already described, with the 
difference, that as the edges of the plate must approach as near 
as possible to the muscles on either side of the alveolar ridge, 
without wounding them, and as the plate at least can be but 
narrow, it becomes imperative that it should be much thicker 
than plates for the upper jaw. This increased thickness will 
both impart the required strength, and present a less trenchant 
edge to the muscles and integuments that necessarily move upon 
it. There is an excellent method of removing this difficulty 
of the sharp edges of the lower plate, when the condition of 
the mouth will admit of it. In many cases the absorption of 
the parts becomes so considerable, as to leave sufficient room 
in the mouth, to construct the lower plate double, especially 
that portion of it which pertains to the back part of the mouth, 
sustaining the molar teeth. The following method of pro- 
cedure will enable the operator to construct a double plate with 
facility. After the ordinary plate has been completed agreea- 
bly to directions already given, cover the upper or lingual sur- 
face with beeswax, and mould or cut it into such form as shall 
represent the exact position which it is desired that the upper 
plate shall assume. Lay the whole on the tin-cast upon' which 
the plate was struck, and after oiling the surfaces of the wax, 



MECHANICAL DENTISTRY. 



259 



plate and mould, with olive oil, cover the whole with plaster, 
sufficiently thick to give it the required strength. This will 
form the basis of a new set of metallic castings, upon which a 
second plate may be constructed, which, being soldered to the 
first plate, and carefully filed and polished, will present very 
smooth and cylindrical surfaces to the tongue, cheeks and lips. 
This sort of double plate, which has long been familiar to the 
profession, is quite unlike those patented machines of modern 
invention, provided with flute-holes like the lamprey, for the 
storage of all kinds of filth, both solid and fluid, which can be 
collected from the mouth, fomented by heat, and rendered exe- 
crable by fermentation. But as these portable nuisances have 
gone, for the benefit of posterity, to the tomb of the Capulets, 
I have resuscitated their memory merely to say, that those 
double plates wdiich I here recommend, in certain cases, are 
wholly unlike them, inasmuch as they are merely air vessels, 
and not depositories of garbage. One advantage of these double 
plates for the lov/er jaw, in addition to that already mentioned, 
is that they enable the artist to use teeth of uniform length, 
giving greater symmetry and beauty to the w^ork — and besides 
this the strength of the piece will be augmented many-fold. 
It should be moreover known to the profession generally, that 
the market is now supplied with gum-teeth, as they are techni- 
cally called, of great beauty, which are very useful in those 
cases of considerable alveolar absorption, where double plates 
are not employed. 

81. Before entering upon the subject of double sets with 
springs, wliich will engage our attention in the next chapter, 
it may, perhaps, be useful to the student to say a few words in 
relation to the several kinds of mineral teeth which have been 
ofiered to the profession from time to time by the principal 
manufacturers of Europe and America. Until a few years ago 
the French dentists took the lead in this branch of manufacture, 
and supplied not only their own country, but foreign markets. 
If we are to judge of the French teeth from the specimens 
sent to this country while there was a demand for them, it must 
be confessed that although the material of both the body and 
the enamel, was exceedingly well calculated to resist the action 
of the blowpipe, and although they were in some instances 



260 



maury's dental art. 



well coloured, yet as to beauty of form and the method of at- 
tachment to metallic plates, they were vastly inferior to those of 
American fabrication which have now wholly supplanted them. 
And in relation to two of these points of superiority, I am com- 
pelled to acknowledge that I have never yet seen any artificial 
mineral teeth, so elegantly formed, and coloured so perfectly 
to nature, as those manufactured by Mr. C. Ash, of London, 
who has kindly forwarded to me a few sets to be exhibited 
next summer at the meeting of the American Society of Dental 
Surgeons in Boston. But, as these teeth manufactured by 
Mr. Ash do not resist the action of the blowpipe in such a 
manner as to be capable of being soldered to plates with solder 
pf sufficient firmness to resist the action of the fluids of the 
mouth, I am confident that some of our American dentists, 
among whom I am happy to rank Mr. Samuel W. Stockton, 
of Philadelphia, and Mr. James Alcock, of New York, have 
presented to the profession the best specimens of incorruptible 
teeth, of which we have any account in the history of our art 
And yet when I contemplate the undeniable superiority of the 
teeth fabricated by Mr. Ash, of London, as regards beauty of 
form and perfection of colouring, I cannot allow myself to 
doubt that higher points of perfection are still to be attained 
in the production of this species of manufacture, as regards all 
those particulars in which the teeth now in market are found 
deficient. There is scope enough to call into activity the ener- 
gies of the most exalted genius, and a field in which enter- 
prise and perseverance will reap a harvest of gold, when the 
profession confess that they are wholly satisfied with the quality 
of this article now so essential to the perfection of our art. 
But I should esteem myself chargeable with manifest injustice 
and ingratitude towards those who have done so much for the 
improvement of mineral teeth, for having spoken thus of the 
defects of the present fabrics, did I not also express my joy 
and astonishment that so much has been done already during 
the present century for this manufacture. 

82. Of the various modes of constructing what are techni- 
cally called plate teeth, I shall deem it necessary to introduce 
but three on this occasion, as being the most conspicuous among 
the many kinds in vogue. 



MECHA.NICAL DENTISTRY. 



261 



The French plate teeth so long as they continued to come to 
our market, were constructed as follows; 




Each tooth had a longitudinal groove on its posterior surface, 
with three points or pivots of platina set firmly in the body of 
the tooth during its fabrication, to which a gold or platina wire 
might be soldered. To this wire when ground to the level of 
the surface of the tooth, a metal back was to be attached by 
soldering. Teeth thus constructed possess a good degree of 
strength, but are not easily replaced in case of accident, and 
therefore the dentists of the United States adopted the follow- 
ing improvement. 




oi*Fwo small platina pivots of wire, are inserted firmly in the 
body of the tooth during the manufacture, designed to be in- 
serted into two corresponding holes in the metal plate. These 
pivots can be both riveted or soldered to the metal oacks. 
Dr. Harrington, of Philadelphia, has recently secured a patent 
for an improvement in these pivots, which consists in forming 
a head on that end of the pivot which is inserted into the tooth, 
as well to prevent it from being drawn out, as to enable the 
tooth to sustain the strokes of the riveting hammer. In the 
fabrication of the American teeth just described, many indi- 
viduals of eminent mechanical genius, have been for some 
years ardently engaged. Many of these dentists manufacture 
only for their own use, and succeed in producing teeth of good 
quality. Among those who have manufactured for the market, 
Mr. S. W. Stockton, of Philadelphia, has been most generally 
patronised, and has received more frequently than any other 



262 



maury's dental art. 



individual, the medals and diplomas of the American Institute. 
Mr. James Alcock, of New York, has also succeeded, after 
years of persevering experiment, in fabricating beautiful teeth, 
and has likewise obtained the medal of the Institute. 

83. The only remaining kind of mineral teeth of which I 
propose to speak, is that from the manufactory of Mr. C. Ash, 
of London. His teeth differ from those already described, in 
having a central, longitudinal cavity or orifice, bushed with 
gold, for the reception of a pivot of the same metal, as fol- 
lows : 



One of the advantages of this method of construction, is that 
teeth of this kind are adapted as well for insertion on roots as 
on plates of metal. Their great excellency is their surpassing 
beauty of form and colour; and when these properties can be 
made compatible with a material capable of resisting the action 
of the blowpipe, little will be left to be resolved by future ge- 
nerations in the problem of constructing artificial teeth. But 
the period when this desirable object will be attained, is left to 
conjecture, and I deem it not too much to say that, the fortunate 
individual who successfully resolves this difficult problem and 
unites the separate excellencies of those three kinds of teeth, 
will not only insure to himself and his family an ample fortune, 
provided he conduct the exclusive manufacture with spirit and 
skill, but will deserve the general thanks of the profession and 
the gratitude of mankind. 




263 



CHAPTER IV. 

Manner of preparing Teeth with spiral Springs. 

Both jaws are often, to a certain extent, supplied with teeth 
without aid of spiral springs; but it is only when the springs 
are employed, (whether any natural teeth remain or not,) that 
the sets are denominated double. Spiral springs, however, 
may be required for securing a single set, or a set for a single 
jaw. But this can rarely happen, except for the fastenings of 
sets for the lower, since those for the upper can, generally, or 
always be confined in a more convenient manner. 

In the preparation of a double set, the plate for the upper 
jaw should be made about five-eighths of an inch wide; the 
width of the lower must be regulated by the height and width 
of the alveolar ridge for which it is designed. 

The alveolar ridge of the lower jaw, is, in some instances, so 
much absorbed as to be scarcely perceptible, and is covered 
over with the integuments of the lower part of the mouth, 
lying in loose folds upon it. The utility of false teeth, espe- 
cially as regards mastication, can never, under such circum- 
stances, be very great. The moving about of the teeth, which, 
on account of the narrowness of the ridge, it is impossible 
wholly to prevent, and the pressure upon the loose integu- 
ments always produce irritation; so that the teeth, instead of 
contributing to the comfort of the wearer, are a source of almost 
constant annoyance. It would, therefore, be better, in cases of 
this kind, wholly to dispense with their use. Should, how- 
ever, an individual whose mouth is thus circumstanced, still 
persist, after he has been apprized of the true state of the case, 
in desiring the insertion of teeth, we should endeavour, as 
much as possible, to obviate the difficulty, by making the platfi 
narrow, and rounding its under edges. But when the plate is 
very narrow, it should be made thick, in order that it may not 
be easily bent. 

Teeth inserted with springs, must be arranged, mounted 
and antagonized, and have their plates fitted and adapted, in the 
same manner, as those that are to be fastened with clasps. 



264 



maury's dental art. 



la order that the teeth, upon the upper and lower plates 
may antagonize properly, we use what has been denomi- 
nated antagonizing models: they are obtained in the following 
manner: — 

" When both plates have been properly adjusted to the mouth;, 
soft bees-wax is to be placed between them, so as to occupy 
the position that the teeth are to assume; to ascertain the 
proper height of the wax, which is to be the 'length of the 
teeth, we must be governed by the lips and profile of the face: 
the centre of the mouth is now marked upon the plates or wax, 
and the whole may then be withdrawn. 

The lower plate must be filled with calcined plaster mixed 
v^ith water to a proper consistency, and extend posteriorly two 
or three inches beyond the plate, and in which two depressions 
are made: these are intended as articular cavities for the plas- 
ter, w^hich is to be poured into the upper plate and extended 
over this. The plaster poured into the lower plate should be 
allowed to set, and then be oiled previous to filling the upper 
plate: this will prevent the two parts from adhering. 

Fastenings for the springs must be attached to the plate be- 
fore we solder the teeth. These are sometimes fixed at the ends 
of the plate, but the proper place for them is on the sides, be- 
tween the bicuspides and molares; for when the springs are 
fastened here, they keep the teeth much more firmly in their 
places, than when fixed at the ends of the plate. These fasten- 
ings consist of small studs of gold, each about the sixth of an 
inch in length, soldered upon the plates near their outer edges, 
and on a line with the outer surfaces of the teeth, having a gold 
pivot or pin, about the thickness of a fine knitting needle, and 
an eighth of an inch in length, projecting at right angles, from 
the outer side of each, towards the cheeks, with a small screw 
and nut on its end. 

The springs are formed either by winding a piece of gold 
wire upon a small round spindle, or by wrapping it upon ano- 
ther piece of wire of the proper size, made fast in a vice. 
The former, however, is the better mode of making them. 
After the gold wire has been wound in this manner, the spindle 
is drawn from it, and the coil that remains, cut to the proper 
length. Another piece of gold wire having a flat head, with 



MECHANICAL DENTISTRY. 



265 



a hole rather larger than the pins attached to the studs and 
being of the thickness of the spindle, and about half an inch 
in length, is next to be inserted in each end of the coil, so as 
to form a kind of eyelet or swivel. 

vSprings are then attached to the upper and lower plates, which 
being thus connected, are placed in the mouth and held in their 
proper places by the action of the springs. 

The wire used for the construction of springs, should be no 
thicker than is absolutely necessary to give to them the re- 
quisite power; and the diameter of the coil should never ex- 
ceed the seventh or eighth of an inch. Their length must be 
regulated by the peculiarities of the mouth. In some cases 
they will have to be much longer than others ; the usual length, 
however, is about an inch and a quarter, but in some instances 
I have found it necessary to make them an inch and three 
quarters. 

When a single set is to be confined in the mouth in this man- 
ner, fastenings for the springs at one end are to be attached to 
one of the natural teeth, on each side in the other jaw. These 
consist of gold caps placed on the teeth, and furnished with a 
pivot or pin, fixed on each of their outer sides, like those be- 
fore described. Where caps are employed, the artificial teeth, 
which are to antagonize with those upon which they are placed, 
should be shorter than any of the others. Gold bands are in 
some cases substituted, with advantage for caps. 



23 



i 

I 



ALPHABETICAL TABLE. 



LIST OF AUTHORS WHO HAVE WRITTEN ON DENTAL SCIENCE OR SUB- 
JECTS RELATING THERETO, WITH THE TITLES OF MANY OF THEIR 
PRODUCTIONS. 

■ '^'^ A. 

ALBERTI. Dissertat. de denlibus serotinis sapientise vulgo dictis. 
Halae, 1737. 

ALBRECHT. Jichere mittel gegen das zahawcli. Hambourg, 

1809. Expedient cure for the odontalgia. 
ALLVEY. Dissertat. de dentitione morbisque ex ea pendentibus. 

Edimb., 1788. 

ANDREE. Dissert, de odontagris ad dentes evellendos necessariis, 

eoriim vi raechanica et applicatione, Lipsiae, 1784. — Dissert. 4e 

prima puerorum dentitione. Lips., 1790. 
ANGERMANN. Theorie pratique de I'art du dentiste; (ouvrage 

allemand, tradiiit sur celui de Laforgue.) Leipsick, 1803, in-8°. 
APIUS. De dentitione praesertim infantum difficili. Ellangise, 

1751. 

ARENIUS. Dissertat. de catarrho et ejus descendentibus, odon- 
talgia, epiphora et otalgia. Rostock, 1663. 

ARNEMANN. Systeme de chirurgie, 2 volumes, (sur la maladie 
des dents,) Goettingue, 1802. 

ARONSON. De la theorie et de la pratique de Tart du dentiste. 
Berlin, 1803, in-8°. (Traduct. en allemand de I'ouvrage de La- 
forgue.) 

AUBRY (J. B. L.) Maladies des gencives. (Dissertation inaugu- 
rate.) Paris, 1816, in-4°. 

AUDIBRAN CHAMBLY. Essai sur I'art du dentiste. Paris, 
1808, in-8°. Refutation sur les dents metalliques. Paris, 1808, 
12 pages. — Traite historique et pratique sur les dents artificielles 



268 



maury's dental art. 



incorruptibles. Paris, 1821,in-8°, 4 fr. — Quelques reflexians sur 
le proces intente au lord Egerdton, comte de Bridgewater, par M. 
Dubois de Chemant, 1826. — Un mot sur la refutation du sieur 
Dubois de Chemant, dentiste. 

AURIVILLIUS. Dissertat. de dentitione difficili. Upsal, 1757. 

AUSSANT. Sur les soins a donner aux dents de seconde denti- 
tion. {Dissertation inaugurate.) Paris, 1828, in-4°, 

AUVITY {Ant.) Premiere dentition et sevrage. {Dissertat. inau- 
gur., Paris, 1812, in-4°.) 

AUZEBI. Principes d'odontologie. Description des differentes 
maladies qui affectent la bouche, et des moyens de les guerir. 
Lyon, 1771, in-12. 

B. 

BAUHINUS. Dissertat. de odontalgia, 1660. 

BAUMES. Traite de la premiere dentition et des maladies, souvent 

tres graves, qui en dependent. Paris, 1806. Un vol. in-8°, 

6 fr. 

BEAUPREAU. Dissertation sur la proprete et la conservation des 

dents. Paris, 1764. — {Voyez aussi Journal de medecine, t. XXI, 

p. 477. — Lettre a M. Cochois sur les maladies du sinus maxil- 

laire. Paris, 1769. 
BECKER. Sur les dents, etc—La Maniere la plus sure, etc. 

Leipzig, 1807, 1810. 
BENNET, A Dissertation on the teeth. London, 1779, in-8°. 
BERDMORE {Th.) A treatise on the disorders and deformities 

of the teeth and gums, illustrated with cases and experiments. 

London, 1770. 
BEURLIN. Dissertat. de dentitione difficili. Altd., 1720. 
BEW {Charles.) Opinions on the causes and effects of diseases 

in the teeth and gums, etc., etc. 1819. 
BLAKE. Dissertat. de dentium formatione et structura in homine 

et variis animalibus. Edimb., 1798. 
BLUMENTHAL {C. A.) Nahere prufung der aetiologie der zah- 

narbeit der kinder gegen Wickman. Stendal, 1799, in-8°. — Sur 

les Connaissances naturelles des dents. Stendal, 1800. 
BOLLET. Maniere de conduire les enfans depuis leur naissance 
jusqu'a r^ge de sept ans, et d'eviter les convulsions, le croup 

et la coqueluche. Paris, 1820. In-8°. 
BOTOT. Le Chirurgien-dentiste, etc. Paris, 1786, in-12.— Avis 

au peuple sur les soins necessaires pour la proprete de la bouche. 

Paris, 1789. In-12. — Moyens pour conserver les dents, 1802. 



ALPHABETICAL TABLE. 



269 



BOURDET. Lettre a M. D., Paris, 1754, et Eclaircissemens an 
sujet de cette lettre. Paris, 1754. — Recherches et observations 
sur toutes les parties de I'art <3u dentiste. Paris, 1756, in-12, 2 
vol., 5 fr. Feiitsch, 17G2. — Soins faciles pour la proprete de la 
bouche et la conservation des dents. Paris, 1759. — Maniere 
simple de maintenir les dents saines et la bouche fraiche. Leip- 
sick, 1762. — Dissertation sur la proprete et la conservation des 
dents. Paris, 1764, in-8°. — Dissertation sur les depots du sinus 
maxillaire. Paris, 1764. 

BRACHMAEND. De Ulceribus dentium fistulosis. Lipsi«, 1733. 

BRENDEL. Dissertat. de odontalgia, 1697. 

BRING. Observ. in hodiernam de dentibus prseeipne hominura 
doctrinam. Lond., 1793. 

BROUWER. Dissertat. de odontalgia. Leyd., 1692. 

BRUNNER (/. B.) Einkitung zu den wissenschaften eines 
Zahnarztes. Wien und, Leipzig, 1766, in-8°. 

BRUNNER [.dd. £nt.) Abhandlung von der hervobrechung der 
milchzffihne. Wien, 1771, A. D. B., XVI, B., p. 619. 

BUCHNER. Dissertat. de cura dentium. Hales, 1752. 

BUCKING. Traite complet sur I'art d'arracher les dents. 1805. 

BUNON. Dissertation sur un prejuge concernant les maux de 
dents des femmes grosses. Paris, 1741, in-4°. — Essai sur les 
maladies des dents, ou on propose de leur procurer une bonne 
conformation des la plus tendre enfance, et d'en assurer la con- 
servation pendant tout le cours de la vie. Paris, 1743, in-12. 
Experiences et demonstrations faites a I'hopital de la Salpetriere 
et a Saint-Come, en presence de I'Academie de Chirurgie, pour 
servir de suite et de preuves a I'Essai sur les maladies des dents. 
1746, in-12. 

BURLIN (i?. Ph.) Dissertat. de dentitione difficili, eto. Altdorf, 
1720. 

C. 

CAIGNE {Francois.) Sur la dentition des enfans du premier age, 

{Dissertat. inaugicr., Paris, 1802, in-4°.) 
CAMPANI (A.) Odontalgia, ossia trattado sopra i denti. De 

Denti e loro cura, e la maniera di estrarli. Fior., 1789. 
CAPURON. Essai sur la luxation de la machoire inferieure, 

{Dissert, inaugurale.) Paris, an 9, in-8°. 
DE CASTRILLO (F. Mart.) Colloquium de dentitione. Valla- 

dolid, 1557, et Madrid, 1570. 

53* 



270 



MAURy's DENTAL ART. 



CATALAN. Memoire, rapport et observation sur I'appareil propre 
a corriger la difFormite qui coiisiste dans le chevauchement de 
la machoire inferieure en avant de la superieure ; difformite vul- 
gairement nommee menton de galoche, 16 pages. Paris, 1826. 

CHEMANT (Dubois de.) Voy, Dubois. 

COLONDRE. Essai sur les plus frequentes maladies des dents et 
les moyens propres a les prevenir et a les guerir. Geneve, 1781. 

CONRING (Herm.) Dissert, de natura et dolore dentium. Helm- 
stadt, 1672. 

CORNELIO {Vittorio.) Statistica odontalgica del Piemonte et in 

especie di Torino per I'anno 1817. Torino, 1818. 
COURTOIS. Le Dentiste observateur, etc. Paris, 1775.— -Sur I'etat 

et les maladies des dents. Gotha, 1778. 
CRAUSE. Dissert, de dentium sensu. Jena, 1704. 
CRAUSIUS. Dissert, de odontalgia. Jena, 1681. 
CRON {Ludw,) Der beym Aderlassen und Zahnausziehen ges- 

chikte Barbiegesell. Leip., 1717, in-8°. 
CUM ME. Dissertatio de dentium historia physiologice, pathologice 

et thcrapeutice, pertractata. Helmst., 1716. 
CURTIS. A Treatise on the structure and formation of the teeth. 

London, 1769. 

CUVIER [F.) Des dents des mammiferes considerees comme 
caracteres zoologiques. Paris, 1822 — 25, un vol. in-8°. avec 100 
pL, 40 fr. 

D, 

D * * L'art du dentiste joint a I'anatomie de la bouehe, in-12. 

DEFRITSCH. Dissert, de dentibus. Vienn., 1772. 

DELABARRE. (Chirurgien-dentiste.) — Dissertation sur I'liistoire 
des dents. In-4°, 1806. — Odontologie, ou Observations sur les 
dents humaines, suivies de quelques idees nouvelles sur le rae- 
canisine des dentiers artificiels. Paris, 1815, in-8°, fig., 2 fr. 50 
c. — Discours d'ouverture d'un Cours de medecine dentaire. 1817, 
in-8°. — Traite de la partie mecanique de l'art du chirurgien-den- 
tiste. Paris, 1820, 2 vol. in-8°, avec pi. 16 fr. Traite de la 
seconde dentition, et methode nouvelle de la diriger, suivie d'un 
Apercu de semeiotique buccale. Paris, 1819, in-8°, fig., 10 fr. 
Discours d'ouverture d'un Cours de stomatonomie. Paris, 1825, 
in-8°, — Methode naturelle de diriger la seconde dentition. Paris, 
1826, in-8°, fig., 3 fr. 

DELMOND. Memoire sur un nouveau procede pour detruire le 
cordon dentaire des six dents anterieures et eviter leur extraction, 



ALPHABETICAL TABLE, 



271 



Paris, 1824, petite broch. — Epltre a M. Marmont, a I'occasioii 
tie son poeme sur rodontoteclinie, 1825, petite broch. 

DESCHAMPS le jeune. Traite ties maladies des fosses nasales 
et de leurs sinus. Paris, 1804, in-8°, 4 fr. 

DESIRABODE, Je ne puis me taire, ou memoire de M. Desira- 
bode. Paris, 1823. in-8°, 75 c. 

DESPRE. Dissertat. de dentitione difficili. Erf., 1720. 

DEVAUT. Essai sur la nature et la formation des dents. [Disser- 
tat, inaugur., Paris, 182G, in-4°.) 

DOWNING (Richard.) A Popular essay on the structure, for- 
mation, and management of the teeth. London, 1815, in-8°. 

DROUIN. Sur les Maladies des dents. Strasbourg, 1761, in-8°. 

DUBOIS. Esquisse sur I'hygiene dentaire, ou Analyse des moyens 
propres a la conservation des dents et des gencives. Paris, 1823. 

DUBOIS DE CHEMANT. Dissertation sur les avantages des 
nouvelles dents et rateliers artificiels, incorruptibles et sans 
odeur. Paris, 1789. — Lettre sur les dents artificielles. Paris, 1790. 
Dissertation sur les avantages des dents incorruptibles de pate 
minerale, etc., Paris, 1824, broch. in-8°. — Memoire pour M. 
Dubois de Chemant contre le lord Egerdton, comte de Bridg- 
water. Refutation des assertions fausses et caloranieuses conte- 
nues dans un libelle dirige par Audibran, dentiste, contre M. 
Dubois de Chemant, sous le pretexte d'un proces intervenu 
entre le lord Egerdton et M. de Chemant. 1826, in-4°. 

DUBOIS-FOUCOU. Expose de nouveaux precedes pour la con- 
fection des dents diles de composition. Paris, 1808, in-8°. — 
Lettre adressee a MM. les denlistes. Paris, 1808, in-8°. 

DUCHMIN. Sur la Carie de dents de lait, (Journal de Trevoux, 
1759, fevrier.) 

DUPONT. Remede contre le mal des dents. Paris. 1633, in-8^ 
DUVAL. Des Accidens de I'extraction des dents. Paris, 1802, 
petite broch, in-8°. Reflexions sur I'odontalgie, consideree dans 
ses rapports avec d'autres maladies. Paris, 1803,, broch. in-8°. 
Experiences et observations pratiques sur les dents plombees, 
qui sont susceptibles de I'influence galvanique. Paris, 1807, 
broch. in-8°. — Recherches historiques sur I'art du dentiste. 
Broch. in-8°, Paris, 1808. Conseils des poetes anciens sur la 
conservation des dents. Paris, broch. in-8°. {Memoire imprime 
dans le Magasin ency elope dique, annee 1805.) — Memoire sur la 
position relative a I'ouverture externe du canal maxillaire, pour 
servir a la demonstration de I'accroissement de la machoire 



273 



mattry's dental art. 



inferieure. — Propositions sur les fistules dentaires, precedees 
des Observations sur la consomption de I'extremite de la racine 
des dents. Paris, 1810, broch. in-8°. — Observations sur I'etat 
des OS de la machoire, dans les ulceres fistuleux des gencives 
€t dans les fistules dentaires. (Extr. du Bulletin de la Faculte 
de Medecine de Paris, 1814, n°. IV.)— Observation sur quelques 
affections douloureuses de la face, considerees dans leur rapport 
avec I'organe dentaire. 1814. — Notice historique sur la vie et les 
Guvrages de M. Jourdain, dentiste. Paris, 1816, broch. in-8°. 
Le Dentiste de la jeunesse, ou Moyens d'avoir les dents belles 
et bonnes. Paris, 1807, in-8°, 3 fr. 50 c, deuxieme edition. 
De I'Arrangement des secondes dents, ou Methode naturelle de 
diriger la deuxieme dentition, soumise au jugemeut de la raison 
€t de I'experience. Paris, 1820, in-8°, 2 fr. 25 c. — Extrait d'un 
naemoire sur I'atrophie des dents. Paris, in-8°. — Notice des tra- 
vaux entrepris sur les dents en France depuis 1790. Paris, 1825 

(1.) 

E. 

EHINGER. Dissertat. de odontalgia. Altdorf, 1718. 
ELOY. Dissertat. de remediis anti-odontalgicis. Viennae, 1772. 
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EUSTACHIUS. De dentibus, (V. Opusc. anatom.) Venet., 1574, 
in-4°. 

F. 

FAUCHARD. Le Chirurgien-dentiste. Paris, 1786, 2 vol. in-12, 
fig., 5 fr. 

FAY. A description of the mode of using the forceps invented for 

the extraction and excision of teeth. London, 1827, broch. in-8°. 
FIG HER. Sur les di verses formes des os de la machoire dans 

plusieurs especes d'animaux. Leipsick, 1800. 
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Paris, 1682, in-12. 
FONZI, Rapport sur les dents artificielles, terro-metalliques. Paris, 

(1.) II serait a desirer pour la science,'que ce savant dentiste et habile 
operateur reunit en un seul ouvrage les nombreux travaux qu'il a publics 
depuis pres de trente ans, et dont il est presque impossible de se procurer la 
collection complete. 



ALPHABETICAL TABLE. 



273 



1808, 8 pages. — Reponse a la brochure de Dubois-Foucou, Paris, 
1808, 6 pages. 

FOUCHON. Propositiones de dentium vitiis. Paris, 1775. 
FOUCOU (Dubois.) V. Dubois. 

FOX {Joseph,) An account of the diseases which affect children 
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teeth. London, 1803. — The history and treatment of the diseases 
of the teeth, gums, etc. London, 1806, in-4°. 

FKANK. Dissertat, de odontalgia. Jense, 1692. 

G. 

GALLETTE. Reflexions sur la cure des dents. Mayence, 1810. 

Sur I'art dentaire. Mayence, 1803. — Chirurgien dentiste, 24 pag., 

1813. Broch. in-12. 
GARldT. Traite des maladies de la bouche, Paris, 1805. in-8°. 

fig., tres-rare. — Systeme de la physiologic, pathologic et thera- 

peutique de la bouche, avec plusieurs avis de Angermann. Leip- 

sick, 1806. 

GENLIS (Z. C.) Progr. observ. de dentitione tertia. Lips., 1786. 

GEOFFROY-SAINT-HILAIRE. Systeme dentaire des mammi- 
feres et des oiseaux, Paris, 1824, 23 pages. 

GERAUDLY. L'art de conserver les dents. Paris, 1737. 

GERBAUX. A practical treatise on the most frequent diseases of 
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tion, etc. London, in-8^., 1823. 

GESHENCK. Sur personon beiderlet geschlechts die zaichne 
gesmedmed tchonzu. Herrhatten. Francf., 1796. 

GILLES {Arnauld.) La fleur des remedes contre le mal de dents. 
Paris, 1622. 

GIRAUD (J.) Die gute mutter, oder abandlung von den mittein, 
seinen kinderueinen starken, danerhalten koerper, besondersein 
gllickliches zahnen zu verschaffen. Brannschw, 1790, in-8°. A. 
D. B. III. B. p. 411. 

GLAUBRECHT. Dissertat. de odontalgia. Argentorati, 1766. 

GOBLIN {D.) Manuel du dentiste a I'usage des examens, Paris, 
1827, in-8^ 5 fr. 

GOECKEL (Eberb.) Epitome theoriae practicae de odontalgia, oder 
Bericht vondem. Zahnweh, nordl. 1688, in-8°. 

GOGUELIN (/. G,) Memoire sur le scorbut. S.-Brieuc, 1804, 1 
vol. in-8°, 2 fr. 50 c. 

GRACBNER {Carl. Auq.) Gedanken, liber das. Hervorkommen 
and Wechsein der Zahne. 



274 



maury's dental art. 



GRASSO. De dentitione difficili. Erfordiae. 

GROUSSET. De la dentition ou du deveioppement des dents chez 
rhorame, {Dissert, inaugur. Paris, 1803, in-8°, 1 fr. 50 c.) 

GRUN. Dissert, de odontalgia. Jena, 1795. 

GUERTIN. Avisos tendentes a conserva^ao dos dentes e sua sub- 
stitui^ao. Paris, 1819, 8 pages in-8°. 

H. 

HEBENSTREIST (/. E.) De dentitione secunda juniorum. Lips., 
1738, in-4°. 

HEBERT. Le citoyen dentiste, etc. Lyon, 1778. in-8°. 

HEISTER. Dissert, de dentiiira dolore. Altd., 1711.— Epistola 
de pilis, ossibus et dentibus in variis corporis humani partibus 
repertis. Helmst., 1743. 

HEMARD (Urbain,) Recherches sur la vraie anatomic des dents, 
etc. Lyon, 1582. in-8°. 

HERNANDEZ. Memoire sur les questions suivantes, faites par 
la societe de medecine de Lyon, en frimaire an 14. — Quels sont 
les signes diagnostiqiies et prognostiques que peiivent fournir 
dans les maladies aigues et chroniques, Vetat de la langue, des 
levres et des dents? — Quelle consequence doit- n en deduire 
dans la pratique? Toulon, 1808, broch. in-8°, 3 fr. 

HERTZ (/. P.) A familiar dissertation on the causes and treat- 
ment of the diseases of the teeth, etc., Lond. 1815, in-8°. 

HESLOPP. Dissert, de dentitione infantum difficili et laboriosa. 
Leid., 1700. 

HEURNIUS. Tractatus de morbis oculorum, aurium et dentium. 
Leid., 1602. 

HEYE. Dissertat. de dolore dentium. Helrastadii, 1672. 

HILSCHER. Dissertat. de odontalgia, Jen., 1748. — Remarques 
sur les dents, fondees sur la pratique. Jena, 1776 et 1801. 

HOFFMANN. Dissertat. de dentibus eorum morbis et cura. Halae, 
1698 et 1714. — Dissertat. de remediis odontalgicis. Halae, 1700. 

HORSTIUS. De aureo dente. Lips., 1595, in-8°. 

HUNTER. Natural history of the teeth and their diseases. Lon- 
don, 1771 ; traduct. latine, 1773 ; allem., 1780. 

HURLOK (J.) A Practical treatise upon dentition. London, 1742, 
in-8°. 

L 

INGOLSTETTER. De aureo dente Silesiaci pueri. Lipsiae, 
1795. 



ALPHABETICAL TABLE. 



275 



J. 

JACKSON. Dissertat. de physiologia et pathologia dentium erup- 

tionis. Edimb., 1778. 
JANKE. Dissertat. de dentibus evellendis. Leps., 1751. — De os- 

sibus mandibulae puerorum septennium. I/eps., 1751. 
JERON (J.) Practische darstellun aller operalionem der Zahnazt 

iieykunst. Berlin, 1804. 
JETUZE. De difficili infantum dentitione. Erfordise, 1732. 
JOSSE. Analyse de I'email des dents. Paris, an 10. {Journal de 

Me de cine.) 

JOURDAIN. Traite des depots dans les sinus maxillaires, des 
fractures et des caries, suivi de reflexions sur toutes les opera- 
tions de I'art du dentiste. Paris, 1761.— Essai sur la formation 
des dents comparee avec celle des os^i Paris, 1766. — Traite 
des maladies et des operations reellement chirurgicales de la 
bouche et des parties qui y correspondent, suivi de notes, d'ob- 
servations, consultations interessantes, tant anciennes que mo- 
dernes, 2 vol. in-8. Paris, 1756- — Nouveaux elemens d'odonto- 
logie. Paris, 1756. 

JOURDAN et MAGGIOLO. Manuel de I'art du dentiste. Nancy, 
1807, in-8°, fig. 2 fr. 50 c. 

JUNKER. Dissertat. de dentium affectibus. Halae, 1740.— -Dis- 
sertat. de dentitione difficili. Halae, 1745. — Dissertat. de quatuor 
praecipuis infantum morbis. 1746. Dissertat. de odontalgia. Halse, 
1758. 

JUNCKER. Sur les maladies des dents et les maux de tete, et 
I'art de les guerir. Braumscliweig, 1802. 

K. 

KEMME. Dissertat. sistens dentium historiam, physiologice, pa- 

thologice et therapeutice pertractatam. Helmst. 1740. 
KOECKER [Leonard.) Principles of Dental surgery, exhibiting 

a new method of treating the diseases of the teeth and gums, etc. 

London, 1826, in-8°. 
KOENEN. Dissertat. de praecipuis dentium morbis. Francof.^ 

1793. 

KRANSE (J?. W.) De odontalgia. Jenae, 1780. 
KRAUTERMANN (Fa/.) Sicherer Augen und Zahnarzt. Arnstadt, 
1732, in-8°. 

KREBEL (/. L. Cottis.) Dissertatio inauguralis d=e dentitione 
difficili. Lipsise, 1800. In-4°. 



276 



maury's dental art. 



KUCHLER. Dissertat. de ulceribus dentium fistulosis. Lips., 
1733. 

KULENKAMP. Dissertat. de difficili infantum dentitione. Har- 
derow, 1788. 

L. 

LAFORGUE. Dix-sept articles relatifs aux maladies des dents. 
Paris, an 8. Broch, in-8°. — L'art du dentiste. Paris, 1802, in-8°. 
fig. — Theorie et pratique de l'art du dentiste. Paris, 1810, 2 vol. 
in-8°. fig. — De la Semeiologie buccale, et Buccamancie. Paris, 
1814, in-8°. — Le Trioraphe de la premiere dentition, almanach 
nouveau et curieux pour Tan bissextile 1816. Paris, 1816, in-32. 

LAUBMEYER. Dissert, de dentibus. Regiora, 1745. 

LAVIGNA {Fr.) Osservazioni odontalgiche suUe cause della carie. 
Turin, 1813, in-8°. 

LAVINI (Guisippe.) Tractado sopre la qualita di denti colmodo 
di cavargli. Fiorenza, 1740. 

LECLUSE. Traite utile au public, ou Ton enseigne la methode 
de remedier aux douleurs et aux accidens qui precedent et qui 
accompagnent la sortie des premieres dents des enfans, de pro- 
curer un arrangement aux secondes, enfin de les entretenir et de 
les conserver pendant le cours de la vie. Nancy, 1750, 1753, 
Paris, 1754. — Nouveaux elemens d'odontologie. Paris, 1754 et 
1782. — Eclaircissement pour parvenir a preserver les dents de 
la carie, etc, Paris, 1755. 

LEGROS. Le conservateur des dents. Paris, 1812. 

LEICHNER {Richard.) Dissert, de atrocissima dentium dolore. 
Erfort, 1678. 

LEMAIRE {Joseph.) Le dentiste des dames^ Paris, 1812, in-12. — 
Deux observations d'anatomie pathologique sur les dents. Paris, 
1816. Cinq pages in-8°. — Histoire naturelle des maladies des 
dents de I'espece humaine. (Translated from the English work 
of Joseph Fox. Paris, 1821, in-4°, avec pi. 20 fr.) — Traite sur 
les dents, physiologic, pathologie. Paris, 1822 et 1824, 3 vol. 
in-8°, 12 fr. 60 c. 

LEMAITRE. Rapport fait a la societe des inventions et decou- 
vertes, sur les dentiers perfectionnes. Paris, 1784. 

LEMONIER. Dissertation sur les maladies des dents. Paris, 1753 
et 1783, in-12.— Lettre a M. Mouton. Paris, 1784, in-8°. 

LENTIN {Leber Beiijam.) Bekerungen von der Wirkung der 
electrischen Erschiitterung im Zahnweh, 1756. 



ALPHABETICAL TABLIS. 



277 



LEROY (DE LA FAUDIGUERE.) Maniere de prevenir et de 
guerir les maladies des gencives et des dents. Paris, 1806, 'm-S°. 

LEVEILLE. Memoire sur les rapports qui existent entre les pre- 
mieres et les secondes dents, et sur la disposition favorable de 
ces dernieres au developpement des deux machoires. [Societe 
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LEVEQUE. Notice sur la necessite de diriger la dentition des 
enfans, les soins que reclament les dents a tous les ages, et les 
moyens a employer pour prevenir, arreter ou ralentir les progres 
des maladies qui afFectent ces organes. Strasbourg, 1823, in-8°. 

LEWIS. An essay on the formation of the teeth with a supplement 
containing the means of preserving them. London, 1772, in-8°. 

LICHTENSTEIN (/. M.) Deber die porgfalt fiir zahnfleisch 
und zahne bremen in-8°. A. Jh. L. Z. 1812, n°. 31. 

LIDDELINS. Tractatus de dente aureo pueri Silesiaci. Hamb., 
1626. (App. ad artem medicam.) 

LIMA. Plusieurs observations sur un nouveau moyen de guerir 
certaines douleurs de dents. Lyon, 1788. 

LOESELIUS. Dissertat. de dolore dentium Regiom (1639.) 

LOESCHER. Dissertat. de dentibus sapientiae, eorumque morbis. 
Witteb. 1728. 

LONGBOTTOM. A treatise on dentistry. Baltimore, in-12. 
LUDOLF {H.) Disputat. de morbis gingivarum. Erfort, 1708 et 
1822. 

LUDWIG. Programma de cortice dentium, Lipsiss, 1753. — Diss, 
de dentitione difficili. Leps., 1800. 

M. 

MAGGIOLLO. Le Manuel de I'Art du dentiste. Nancy, 1807, 

in-12, fig., 2 fr. 50 c. 
MAHON. Le Dentiste observateur, Paris, an vi, in-12, 1 fr. 50 c. 
MARMONT (/.) L'Odontotechnie, ou I'Art du Dentiste, poeme 

dictatique et descriptif, en quatre chants, dedie aux dames, Paris, 

1825, in-12. 

MARTEL (iV. M.) Sur I'Odontalgie et les affections qui la sirau- 
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MARTIN. Dissertation sur les dents. Paris, 1679, in-12. 

MAURY (/. G. F.) Manuel du Dentiste, pour rapplication des 
dents artificiell^^s incorruptibles, suivi de la description de divers 
instrumens perfectionnes. Paris, 1820, in-8°. 2*=. edit., princi- 
palement augmentee du mode de fabrication des dents incorrup- 
tibles. Paris, 1822, in-8°, fig., 3 fr. 
24 



278 



maury's dental art. 



MEKEL. Dissertat. An morbi, qui Dentium translatioiiem se- 
quuntur, venerei sint necne ? Hal., 1792. 

MEYER (J.) Abhandlung von der gewohnhichen Zahnkrankheiten. 
Hanau, 1778, in-8°. 

BlIEL. Note sur la maniere dont les dents sortent des alveoles et 
traversent les gencives, lue a la Societe medico-pratique. 1810. 
Quatre pages in-8°. — Description d'un nouvel instrument pour 
executer facilement une operation occasionee par la fracture des 
pivots des dents artificielles dans les racines qui les resolvent ; et 
quelques vues sur la tbrme la plus avantageuse a donner a ces 
pivots. Paris, 1808. Huit pages. — Quelques idees sur le rapport 
des deux Dentitions et sur raccroissement des machoires dans 
riiomme ; Paris. Vingt-cinq pages in-8°. — Recherclies sur I'Art 
de diriger la seconde dentition en general. Paris, 1826, in-8°, 
fig., 4 fr. 50 c. 

MOEBIUS. De Odontalgia sen de dentium statu naturali atque prae- 

ternaturali. Jenae, 1661, in-4°. 
MONAVIUS. De dentium affectibus. Basil., 1578. 
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ranti ejusdem evulsio, 1740. 
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Paris, 1783, in-12. 
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MOUTON. Essai d'Odontotechnie, ou Dissertation sur les Dents 

artificielles. Paris, 1786, in-12. 
MURPHY (Joseph.) A Natural History of the human teeth with 

a treatise on their diseases from infancy to old age, etc. London, 

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MYRRHEN. Dissertat. de Odontalgia, Giess, 1693. 

N. 

NEDHART. De Aff'ectibus Dentium. 

NICOLAI. Dissertat. de variis dentium afi'ectibus eorumque in 
sanitatem influxu. Jense, 1799. 

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OETINGER. Dissert, de Ortu Dentium, etc. Tub., 1770. 
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reproduction des dents chez les lapins, considerees sous le rapport 



ALPHABETICAL TABLE. 



279 



de leur application a I'etude de I'organisation des dents humaines. 
Paris, 1823, broeh. in-8°- 

P. 

PACHEUS. Dissert, de Dentium dolore. Basil., 1707. 
PALDAMUS. Dissert, de Dentium morbis. Hal., 1799. 
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PARMLY {L. S.) A Practical guide to the management of the 
teeth, comprising a discovery of the origin of caries, or decay of 
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Lectures on the natural history and management of the teeth, 
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PARMILY [EUazar.) An Essay on the disorders and treatment of 
the teeth. In-8°. London, 1821. 

PASCH {Jos. Ge.) Abhandlung von den Zahnen, des Zahufleisches- 
der-Kiefer, Krankheiten und Heilart. Wien, 1767, 

PAUL!. Dissert, de Dolore dentium. Hafnias, 1639. 

PESTORF. Dissert, de dentitione difficili. Ultr., 1699. 

PLANER. Dissert, de Odontalgia. Tul., 1695. 

PLENCK {J.-J.) De Dentium et gingivarum morbis. Wien, 1778. 
Neapel, 1781. Tentsch. Wien, 1779. In-8°. 

PLISSON. Observation sur une maladie extraordinaire des gen- 
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PLOUCQUET. Dissertat. Odontidis primse lineas. Tub. 1794. 

POLH (Pr.) De Difficili infantum Dentitione. Lips., 1776. 

POSE WITZ. Semeiologie aphtharum idiopaticarum et symptoma- 
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R. 

RAN, Dissertat. de Ortu et Generatione dentium. Lugd. Bat., 
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REGNART. Memoire sur un Nouveau moyen d'Obturation des 
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RENGELMANN {Carol, Jos,) De ossium morbis, eorumque in 
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RICCL Principes d'Odontotechnie, ou Reflexions sur la Conser- 
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dents raciformes ou racisuberiques. Paris, 1816, in-8°. — Instruc- 
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280 



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RINIERE. Instructions pour conserver les dents, Paris, 181 1. 
liOLFINCK. Dissert, de Odontalgia. Jena, 1669. 
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dentition. Paris, 1820, in-4°. — Anatomic comparee du Systeme 

dentaire chez Fhomrae et les principaux ; Paris, 1827. Grand 

in-8°, avec 30 pi., SO fr. 
ROUX (Ph. Jos.) Memoire sur la Staphyloraphie ou Suture du 

voile du palais. Paris, 1825, in-8°. fig. 2 f. 50 c. 
RUBICKI. Dissert, de Dentitione difficili. Regiom., 1803. 
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various diseases. London, 1779, in-12. 

S. 

SCARDOVI. Dissert, de dentibus. Argent., 1645, in-4°. 
SCHEERS. Dissert, de dentibus. Traject., 1772. 
SCHELHAMMER. Dissert, de odontalgia tactu sananda. Jena, 
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SCHMIDT. L'art de maintenir les dents depuis I'enfanee. Gotha, 
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SENNERTUS. Dissertat. de denlium dolore. Witteb., 1629. 

SERRES (E. R. A.) Essai sur Panatomie, la physiologic des 
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4 fr. 50 c. 

SIGMOND. A practical and domestic treatise on the diseases and 

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ALPHABETICAL TABLE. 



281 



T. 

TAVEAU (0.) Hygiene de la bouche. Paris, 1826, in-12, 3 fr.— 

Conseils aux fumeurs sur la conservation de leurs dents. Paris, 

1827, in-8°. 2 f. 50 c. 
TIMAEUS. A treatise on the tooth-ache. London, 1769, in-8°. 
TOIRAC. Sur les dents considerees sous le rapport de la sante, 

de la physionomie, de la pronunciation. {Dissert, inaugur, 

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TOLVER (A.) A treatise on the teeth. London, 1752, in-8°. 
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Societe de medecine de Paris: suivie de remarques sur les dents 

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TRASTUS (Th.) Disput. de dentibus in disp. et epist. Tiguri, 

1595, in-4°. 

TROUBAT. Accidens d'une dentition difficile ou laborieuse : 
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TRECURTH. Dissertat. de odontalgia. Hal., 1688. 

TULLER. A popular essay on the structure, formation and ma- 
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V. 

VACHER. Dissertat. de dentium accidentibus. Paris, 1764 et 
1767. 

VALENTIN!. Dissertat. de vacillatione, casu et reparatione den^ 

tium. Giess., 1727. 
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les gencives. Gotha, 1802. — Le Dentiste pour tous les etats. 

Leipsick. 1803. — Comment les parens peuvent^ils faciliter les 

moyens de faire les dents aux enfans. Pyrna, 1807. 
VASE. Ergo haemorrhagia ex dentium evulsione, chirurgici incu- 

ria, lethalis ? Paris, 1735. 
VATER. Dissertat. de odontalgia. Witteb., 1683. 
VESTI. Dissertat. de odontalgia. Erf., 1697. 
VIGIER {J.) Tractatus de catarrho, rheumatismo, vitiis dentium, 

Genev., 1620, in-8°. 
VAUQUELIN. Rapport sur le tartre des dents, fait a la section d^ 

Pharmacie de V Academic royale de Medecine. Paris, 1825. 
24* 



282 



maury's dental art. 



w. 

WAGNER. Dissert, de dentitione difficili a dubiis C. L. Wich- 

mann vindicata. Jen,, 1798. 
VVALKEY. On the diseases of the teeth, their origin explained. 

Lend., 1793. 

WARENIUS. Dissert., de catarrho et ex eo descendentibus, 

odontalgia, etc. Rostoch, 1663. 
WEDEL. Dissert, de dentitione infantum. Jen., 1678. 
WEYLAND {Fr. S.) Disput. de ozena maxillari cum ulcere fis- 

tulosa ad angulum oculi internum complicato. Argentorati. 1771, 

in-4°. 

WOOFFENDALE. Practical Observations on the human teeth. 
London, 1788, in-8°- 

Z. 

ZAKBOCKJEN. Bevattende de middelen om de gezondheit der 
tanden te berwaaren, derzelver Zieklyke toevalle te voorkomen 
en te keer to gaan Arnheim. 1804, in-12. 

ZBONATREIT. De Dentitione secunda juniorum. Leipsig, 1738. 
in-4°. 

ZEIDLER. Dissertat. de dolore dentium. Lepsiae, 1631. 
ZIEGLER (Fr.) Disputat. de morbis praecipuis sinuum ossis 

frontis maxillae superioris et quibusdam mandibulse inferioris. 

Rinteln, 1750. 

ZIEGLER. Diss., 1613.— Dissert, de odontalgia. Uttraject., 1695. 



Journals and Periodicals, containing interesting documents upon 
the Structure of the Teeth, their diseases, and the Therapeutical 
means of remedying these, 

Academie royale de Medecine. 

Acta Eruditorum Lipsiae. 

Acta Helvetiae. 

Acta Naturae Curiosorum. 

Acta [Nova) Naturae Curiosorum. 

Bulletin de la Faculte de Medecine de Paris. 

Commercium litterarium. 

Encyclopedie par ordre de matieres. 

Epheraerides des Curieux de la nature. 

Journal de Medecine et de chirurgie. 



ALPHABETICAL TABLE. 



283 



Journal general de Medecine. 

Journal der Practischen Heilkunde (Hufeland.) 

Journal der Erfindungen, etc. 

Physical and medical Journal. 

Journal des Savans. 

Memoires de la Societe medicale d'Emulation. 
Memoires de la Societe royale de Medecine. 
Recueil periodique de la Societe de Medecine. 
Medical Repository. 
Transactions pliilosophiques. 



APPENDIX TO LIST OF AUTHORS, &c. 

BY THE • TRANSLATOR. 

American Journal of Dental Science, Svo. vol. 1, 1840-'!, New 

York, C. A, Harris. M. D. and Eleazar Parmly, M. D., Editors. 

Do. vol. 2, 1841-'2. 
Baltimore, C. A. Harris, M. D., D. D. S., Solyraan Brown, M. 

D., D. D. S., Editors.— Do. vol. 3. 1842-3. 
(Now issuing,) C. A. Harris, M. D., D. D. S., Solyman Brown, 

M. D., D. D. S, Leonard Mackall, M, D., Editors. 
ASHBURNER J, M. D., on Dentition, 12mo. London, 1834. , 
BLANDIN, P. F., Anatomic du Systeme Dentaire, 8vo. Paris, 

1836. 

BROWN, SOLYMAN, M. D., Dentologia, a Poem on the Dis- 
eases of the Teeth, and their proper Remedies, Svo. 1833. New 
York. 

BURDELL, J. &; H. On the Structure, Physiology, Anatomy and 
Diseases of the Teeth, 8vo. New York, 1838. 

CLARK, J. P. A practical and familiar Treatise on the Teeth and 
Dentism, 8vo. London, 1836. A new System of treating the 
human Teeth, 12mo. London, 1841. 

CHANNING, F. B. Remarks on the Importance of the Teeth, 
(fee, &c., 8vo. Richmond, 1833. 

DE LONDE, S. C. On surgical, operative and mechanical Den- 
tistry, 8vo. London, 1840. 

ETTMULLER, C. F. B. Medizenisch Chirurgische Abhandlung 
uber die Krankheiten der zhne, &c. Leipzig, 1798. 

FLAGG, J. F., M. D. Family Dentist, 12mo. Boston, 1832. 

FULLER. Popular Essay on the Structure, Formation and Ma- 
nagement of tlie Teeth, 12mo. 1815. 



284 



maury's dental art. 



GRAY, JOHN. Preservation of the Teeth, 12mo. London, 1840. 

HARRIS, C. A., M. D., D. D. S. Dental Art, a practical Treatise 
on Dental Surgery, 8vo. Bait., 1839. — Essay on the Charac- 
teristics of the Teeth, Gums, (fee, 8vo. Baltimore, 1841. 

HITCHCOCK, D. R. Preservation of the Teeth, a Family Guide, 
12mo. Boston, 1840. 

IMRIE, W. The Parents' Guide, <fec., 8vo. London, 1835. 

JAMET, C. A. Traite des Dents, 8vo. Paris, 1839. 

JOBSON, D. M. Treatise on the Anatomy and Physiology of the 
Teeth, &c., 8vo. London, 1835. 

KOECKER, L., M. D. Essay on artificial Teeth, Obturators, and 
Palates, 8vo. London, 1835. 

KOECKER, L., M. D. Essay on the Diseases of the Jaws, 8vo. 
London, Philadelphia, 1834. 

LIN TOD, W. On the Structure, Economy and Pathology of the 
human Teeth, 12mo. London, 1841. 

LEFOULON, J. Nouveau traite Theorique et Pratique de TArt 
du Dentiste, 8vo. Paris, 1841. 

LINDERER, C. J. & J. Handbuck der zachnheilkunde enthaltend 
Anatomic und Physiologic Materia Medica Dentaria und Chirur- 
gia, &c., 8vo. Berlin, 1842. 

MURPHY, J. L. Popular Treatise on the Structure, Diseases and 
Treatment of the human Teeth, 12mo. London, 1837. 

MALLAN, JOHN. Practical Observations on the Physiology and 
Diseases of the Teeth, 8vo. London, 1835. 

NICHOLLES, JOHN. On the Teeth, 8vo. London, 1833. 

NASMYTH, A. Three Memoirs on the Developement and Struc- 
ture of the Teeth and Epithelium, 8vo. London, 1841. — '* His- 
torical Introduction to the Anatomy, Physiology and Diseases of 
the Teeth," 8vo. London, 1839. 

PARMLY, L. S., M. D. A practical Guide to the Management of 
the Teeth, 8vo. 1819, New York. 

PURLAND. Practical Directions for preserving the Teeth. Lon- 
don, 1831. 

PLOUGH, A. L. Observations Generales sur I'importance des 

Dents. New Orleans, 1836. 
ROBERTSON, W. A practical Treatise on the human Teeth, 8vo. 

London, 1839. 

SPOONER, S„ M. D. Guide to sound Teeth, or a popular Treatise 
on the Teeth, 12mo. New York, 1836. 

SAUNDERS, E. Advice on the Care of the Teeth, 13mo. Lon- 
don. 



ALPHABETICAL TABLE. 



285 



SNELL, J. A practical Guide to Operations on the Teeth, 8vo. 

London — Philadelphia, 1832. 
SCOTT, J. Every Man his own Dentist, 8vo, London, 1838. 
SPOONER, S. Dissertatio medica inauguralis de generis humani 

Dentium Philologia et morbis, 8vo. New York, 1835. 
SCHANGE, J. M. A. Precis sur le Redressement des Dents, etc. 

etc. 8vo. Paris, 1842. 
TRINOR, J., M. D. Physiological Inquiry into the Structure or 

Organization and Nourishment of the human Teeth, 8vo. New 

York, 1828. Observations on Neuralgia, 1830. 
WAITE, G. Surgeon Dentist's Manual, London — Philadelphia, 

1830. — On the Gums, 8vo. London — Philadelphia, 1838. 
WARDROPER, W. On the Structure, Diseases and Treatment of 

the Teeth, 8vo, London, 1838. 



EXPLANATION OF PLATES. 



EXPLANATION OF PLATE L 



Figure 1. A head exhibiting the muscles of the face. 
2. A head exhibiting the distribution of the 
superficial temporal nerve, and the supe- 
rior and inferior maxillary nerves. 



riJ. 




25 



EXPLANATION OF PLATE IL 



Figure 1. Superior and inferior jaws, the external 
plate of bone removed to exhibit the 
roots of the teeth and the nerves pene- 
trating them. 
2. Superior and inferior jaws, the internal 
plate removed to exhibit the arteries and 
> veins that are distributed to the dental 
pulp. (The arteries are designated by 
dots, the veins by lines.) 



J 

] 



EXPLANATION OF PLATE III 



First Dentition. 

Superior Teeth. 

Figure 1. Central Incisor of a child of three months, 

2. Lateral " " " 

3. Cuspidatus " " 

4. First Molar " " 

5. Second Molar 

6. Central Incisor of a foetus of eight months. 

7. Lateral 

8. Cuspidatus " " 

9. First Molar " " 
10. Second " 



Inferior Teeth. 

11. Central Incisor of a foetus of eight months. 

12. Lateral " " 

13. Cuspidatus " . " 

14. First Molar 

15. Second " 

16. Central incisor of a child of three months. 

17. Lateral " " 

18. Cuspidatus 

19. First Molar 

20. Second " 

Second Dentition. 

Superior Teeth. 

21. Central Incisor of a child of seven years. 

22. Lateral 

23. Cuspidatus " , " 



i 



EXPLANATION OP PLATE III. — CONTINUED. 293 



Figure 24. First bicuspis of a child of seven years. 

25. Second " 

26. First Molar " 

27. Second " " 

28. Central Incisor of a child of five years. 

29. Lateral 

' 30. Cuspidatus " 

31. First bicuspis " " 

32. Second " 

33. First Molar 

34. Second " " 



Inferior Teeth. 

35. Central Incisor of a child of five years. 

36. Lateral 

37. Cuspidatus " 

38. First Bicuspis " 

39. Second " 

40. First Molar " 

41. Second " 

42. Central incisor of a child of seven years. 

43. Lateral " " 

44. Cuspidatus " " 

45. First bicuspis " " 

46. Second " 

47. First Molar " 

48. Second " " " 



25* 



EXPLANATION OF PLATE IV. 



Figure 1. A preparation showing the dental matrices 
of two central incisores of second denti- 
tion, and their communication with the 
gum by a conduit called iter dentis. 

2. Dental matrix containing the crown of a 

central incisor of second dentition. 

3. A decayed tooth, exhibiting a cyst at the 

extremity of its root. 

4. A central incisor of second dentition of a 

child of sevcQ years, sawed longitudi- 
nally, the dental pulp having fallen out. 

5. The half of figure 4, showing the situation 

that the dental pulp had occupied. 

6. A bicuspis exhibiting stationary decay. 

7. A central incisor sawed in two, showing 

the obliteration of the dental canal at 
about the age of sixty. 

8. Profile of a person fourteen years old, 

having an inversion of the dental arch. 
{Mentoji de Galoche.) 

9. The same profile at fifteen years of age 

showing the teeth after having been well 
arranged. 




The f.Sin c^xi?- citft 



EXPLANATION OF PLATE V. 



Figure 1. The half of the inferior jaw of a child at 
birth, the exterior plate removed, show- 
ing the dental gums. 

2. The same at eight months, the incisores 

beginning to appear. 

3. The same at sixteen months, the incisores 
being entirely through the gums. 

4. The same at 23 months, the cuspidatus 

commencing to appear. 

5. The same at 31 months, the first molar 

having commenced to appear. 

6. The same at 40 months, the first and second 

molares of first dentition having appeared. 



n. J. 




EXPLANATION OF PLATE VL 



Figure 1. The half of the inferior jaw of a child from 
six to seven years old, the central incisor 
of second dentition commencing to ap- 
pear. (The first molar also appears at 
this age.) 

2. The same, from 11 to 12 years of age, the 

second molar nearly ont, and the germ of 
the wisdom tooth exhibited. 

3. Adult, dentition being complete. 

4. Old age, all the teeth being removed, the 

alveoli are obliterated so as to form a 
solid border, which serves in a measure 
for mastication. 



Tl. d 




I 



EXPLANATION OF PLATE VIL 



THE FORMS OF THE TEETH OF FIRST DENTITION. 

Superior Teeth, 
Figure 1. Central Incisor. 

2. Lateral Incisor. 

3. Cuspidatus. 

4. First Molar. 

5. Second Molar. 

Inferior Teeth 

6. Central Incisor. 

7. Lateral Incisor. 

8. Cuspidatus. 

9. First Molar. 

10. Second Molar. 

THE FORMS OF THE TEETH OF SECOND DENTITION. 

Superior Teeth. 

11. Central Incisor. 

12. Lateral Incisor. 

13. Cuspidatus. 

14. First bicuspis. 

15. Second bicuspis. 

16. First Molar. 

17. Second Molar. 

18. Third Molar. 

Inferior Teeth, 

19. Central Incisor. 

20. Lateral Incisor. 

21. Cuspidatus. 

22. First bicuspis. 

23. Second bicuspis. 

24. First Molar. 

25. Second Molar. 

26. Third Molar. 



26 



EXPLANATION OF PLATE VIIL 



Figure 1. A molar tooth with a speck of enamel on 
its root. 

2. A wisdom tooth of the inferior jaw having 

four roots and diminutive tooth adhering 
to it. 

3. First superior molar with a diminutive 

tooth adhering to it. 

4. Two superior incisores united. 

5. A superior central incisor with its root 

curved obliquely. 

6. Supernumerary tooth. 

7. Second and third inferior molares united. 

8. A lateral incisor having a diminutive tooth 

upon its heel. 

9. A drawing of two incisores of a child three 

years old, each having a young tooth 
upon its heel. 

10. The form of a supernumerary tooth and 

a diminutive of the wisdom tooth, which 
grow near the last superior molar. 

11. A supernumerary tooth. 

12. The first superior molar having a bicuspis 

embraced between its roots. 

13. A superior incisor having a root in the 

form of a bayonet. 

14. A first superior bicuspis having three roots. 

15. Two inferior central incisores of first den- 

tition united. 

16. Form of a supernumerary tooth growing 

between the superior central incisores. 

17. The root of a molar having in its centre a 

diminutive tooth. 




T.Smc'/aij-'s YrAJVzzIa. 




I 



J 



EXPLANATION OF PLATE VIII. — CONTINUED. 



303 



18. Two inferior bicuspides united to a single 

root. 

19. An inferior cuspidatus bifurcated. 

20. First superior molar having four diver- 

gent roots. 

21. A superior wisdom tooth having a very 

large crown, and scarcely any root. 

22. The second superior molar of very large 

size. 

23. A superior molar, having a supernumerary 

tooth united to its root. 



EXPLANATION OF PLATE IX. 



Figure 1. A superior jaw in which is developed in 
the substance of the bone two supernu- 
merary teeth which made their appear- 
ance under the nasal fossa. They are 
inverted. 

2. The right supernumerary tooth forming a 

part of figure 1. 

3. The left supernumerary tooth forming part 

of figure 1. 

4. The central incisor of figure 1, its root 

formed like a bayonet. 

5. The right side of a superior jaw viewed 

internally, the left central incisor directed 
toward the wing of the nose. 

6. Position of the two central incisores of 

figure 5. 

7. Central incisor of figure 5 viewed anteriorly. 

8. Central superior incisor having a diminu- 

tive root. 

9. A supernumerary tooth situated between 

the two central superior incisores. 
10. A lateral superior incisor having its root in 
the form of a bayonet. 



EXPLANATION OF PLATE X. 



Figure L A superior jaw in which are seen two 
wisdom teeth, one above the other. 

2. Drawing of a superior jaw, having a con- 

genital depression about nine lines deep, 
in the form of the figure 8. The subject 
from whom it was taken spoke and sang 
well. 

3. An inferior jaw, the six anterior teeth pro- 

jecting outwardly. The corresponding 
teeth of the superior jaw having been lost. 

4. A molar tooth having osselet or deposition 

of bone in the place occupied by the 
dental pulp. 



J' £./(?. 




litk of T. Smc7azr,J'/'z^. 




1 



EXPLANATION OF PLATE XL 



Figure 1. Superior lateral incisores growing within 
the dental arch, a ligature attached to 
bring them into their proper positions. 

2. A small platina band with two curves and 

a hook, used with the ligatures to turn a 
central superior incisor, having its lateral 
surface presented anteriorly. 

3, 4, 5, 6. Various hooks used to prevent 

ligatures slipping down on the gums. 

7. A ligature and hook adjusted to regulate a 

central incisor above the level of the 
other teeth. 

8. Inversion of the dental arches: ligatures 

placed upon the inferior teeth to adjust 
them. 



EXPLANATION OF PLATE XIL 



Figure 1. Calcareous decay of a central incisor. 

2. Peeling decay. 

3. Diruptive decay. 

4. 5. Black decay. 

6. Perforating decay. 

7. Erosion upon the roots of the inferior in- 

cisores. 

8. Erosion upon an inferior molar. . 

9. Erosion upon a superior molar. 

10. Destruction of a part of a root above which 

existed an epulis. 

11. Stationary decay upon the crown of a 

molar. 

12. Several lines of erosion upon twelve teeth 

of the same subject. 

13. The destruction of a portion of the root of 

a lateral incisor produced by inflamma- 
tion of the alveolo-dental membrane, the 
nerve remaining healthy. 

14. Commencement of external decay, pro- 

gressing toward the dental nerve. 

1 5. Internal decay making its appearance upon 

the external table of the crown of a tooth. 

16. Exostosis on one root of a molar. 

17. Exostosis on an inferior lateral incisor, in- 

volving the whole length of the root. 

18. Exostosis on a central incisor. 

19. Exostosis of the root of a molar. 

20. Exostosis of an inferior bicuspis. 

21. Exostosis of a superior cuspidatus. 



EXPLANATION OF PLATE XIIL 



Figure 1. Sequestra of a branch of the inferior jaw, 
decayed in consequence of the unskilful 
extraction of a tooth. 

2. Cutting edge of a central incisor fractured 

by a blow. 

3. The internal face of a central incisor en- 

tirely worn away by the friction of the 
inferior teeth. 

4. A central incisor, the crown of which is 

nearly worn away by the perpendicu- 
lar friction of the corresponding inferior 
teeth. 

5. An incisor worn away by the continued 

use of badly prepared dentifrices and 
hard brushes. 

6. A cuspidatus tooth worn away by the clasp 

of an artificial piece. 

7. An oblique fracture of the crown of a tooth. 

8. Decay of the maxillary bones, the teeth 

remaining sound. 

9. Inferior incisores and cuspidati covered 

with tartar to the extremities of their 
roots, all of which came out together. 

10. First inferior molares extracted at the ages 

of thirteen and fourteen years respec- 
tively. 

11. An inferior wisdom tooth situated obliquely 

in the substance of the maxilla. 

12. A superior central incisor with a very 

crooked root. 



n /J 




Zitlz. ofTho^ Sinclaz?', FMla. 



27 



EXPLANATION OF PLATE XIV. 



Figure 1. The fish-tongue adapted to a handle. 

2. An elevator for the extraction of teeth. 

3. A blade of a lancet somewhat curved, 

mounted upon a shaft, and constructed 
so as to assume various positions. 

4. The straight blade of a lancet adapted to 

the handle of figure 3. 
^ 5. Two small steel semitubes terminating in 
a saw, the opposite extremities adapted 
to a shaft, and this inserted in a socket- 
handle. 

6. Half of a tube (figure 5) viewed internally. 

7. Two steel spiral branches adapted to the 

uses of figure 5. 




ZiI-h ofT/iof SincZazT'Tkila. 



/ 



\ 



EXPLANATION OF PLATE XV. 



Figure 1. A pair of curved excising forceps. 

2. A pair of straight excising forceps. 

3. The curved forceps grasping a tooth to be 

excised. 

4. A molar excised at its neck with num- 

ber 1. 

5. The crown of this molar viewed internally. 

6. A piece of wood used as a fulcrum or sup- 

port for instruments in the extraction or 
excision of teeth. 



rus. 




Zith. of jT/icf SuziJa.ij'^ThiZa. 



27 



EXPLANATION OF PLATE XVL 



Figure 1. A well developed superior jaw of a Hot- 
tentot. 

2. Teeth, of an African, a portion of them 

near the cutting edge properly removed. 

3. The teeth of a Soosoos (African) separated 

to their necks, according to the custom 
of that people. 

4. The teeth of a Madurian, cut away on the 

anterior side, forming transverse gutters. 

5. Teeth of a native of Cabinda, upon the 

coast of Africa, carved in such a manner 
as to give to eight the appearance of four. 

6. Teeth of a Mandingue, on the coast of 

Africa, carved like the teeth of a saw. 




ZWt o£Thof SincIair-.TItiZa. 




I 



EXPLANATION OF PLATE XVIL 



Figure 1. The root of a tooth prepared to receive an 
artificial crown. 

2. An artificial tooth with the pivot adjusted 

to it. 

3. The half of a root, showing the manner in 

which it should be drilled for the recep- 
tion of an artificial crown. 

4. The half of a natural tooth viewed inter- 

nally, representing the screw-tap to re- 
ceive the pivot. 

5. A pivot furnished with a screw at one end 

and slight notches at the other. 

6. The half of a natural tooth seen posteriorly, 

in which is a pivot through which a pin 
passes. 

7. A pivot screwed into a tooth. 

8. A pivot to which is soldered a metallic heel- 

9. An incorruptible tooth previous to being 

soldered to the pivot in figure 8. 

10. The root of a tooth, its canal nearly de- 

stroyed, 

11. A funnel or tube intended to partially fill 

up the root of figure 10. 

12. A natural tooth with a pivot attached pre- 

vious to being adjusted to figure 10 by 
means of the tube figure 11. 

13. Six incorruptible teeth mounted upon a 

plate secured in the mouth by two pivots. 

14. A piece of sea-horse tooth carved for the 

reception of several natural crowns. 

15. Superior and inferior dentures of sea- 

horse tooth, having sixteen natural ante- 
rior teeth adjusted to it. 

16. Sixteen natural teeth riveted and prepared 

for attachment as above. 



EXPLANATION OF PLATE XVII. CONTINUED. 321 

17. A sea-horse tooth base prepared to re- 

ceive two incisores to be adjusted upon 
screws. 

18. The incisores previous to being attached 

as above. 

19. Two incorruptible teeth mounted upon a 

plate to be secured by means of clasps. 

20. Incorruptible piece of three teeth, to be 

attached by ligatures to adjacent teeth. 

21. Inferior dentures of sea-horse nearly de- 

composed by long retention in the mouth. 



EXPLANATION OF PLATE XVIIL 



Figure 1. A metal mould for stamping metallic plate. 

2. Metallic plate stamped upon the mould 

figure 1, and prepared to be tried in the 
mouth. 

3. The same plate provided with a pivot to 

be attached to the root, and four small 
pivots to which the incorruptible teeth 
are to be soldered. 

4. The same plate, the four teeth and two 

clasps attached. 

5. An incorruptible tooth soldered to a plate, 

and to be retained in the mouth by two 
clasps. 

6. A metallic plate with two clasps and two 

pivots for the reception of incorruptible 
teeth. 

7. Figure 6, the two teeth attached. 

8. Figure 7, a small plate soldered behind 

the teeth. 

9. Five teeth to be adjusted to two molares 

by means of two clasps. 

10. Three incorruptible teeth to which are 

attached metal heels. 

11. Seven teeth to be attached principally by 

one long clasp. 



EXPLANATION OP PLATE XIX. 



Figure 1. Form of a superior alveolar ridge with 
only the wisdom teeth remaining. 

2. Form of an inferior alveolar ridge with 

only the wisdom teeth remaining. 

3. The superior and inferior jaws with com- 

plete artificial dentures. 

4. A palatine roof, exhibiting the partial loss 

of the osseous and soft parts. 

5. Portion of the necrosed bone taken from 

the palatine roof figure 4. 



324 



EXPLANATION OP PLATE XX. 



EXPLANATION OF PLATE XX. 



Figure 1. Obturator with branches adapted to figure 
4, pi. XIX. 

2. Superior and inferior dentures with spiral 

springs. 

3. A part of the inferior denture intended for 

the support of the superior denture. 

7. Obturator with branches. 

8. Palatine roof upon which is indicated by 

lines the situation for an obturator. 

9. An obturator secured by means of sponge. 

10. An obturator secured by a button. 

11. An obturator with teeth attached. 



I 



THE END. 



